Provider Demographics
NPI:1609023258
Name:STEVENS, DANIEL N (PHARM D,)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PHARM D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 E MCKELLIPS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2626
Mailing Address - Country:US
Mailing Address - Phone:480-733-0437
Mailing Address - Fax:
Practice Address - Street 1:1151 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2626
Practice Address - Country:US
Practice Address - Phone:480-733-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist