Provider Demographics
NPI:1629482567
Name:STEPHENS, JESSICA COURTNEY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:COURTNEY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:COURTNEY
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:AL
Mailing Address - Zip Code:35952-7614
Mailing Address - Country:US
Mailing Address - Phone:256-328-0481
Mailing Address - Fax:
Practice Address - Street 1:3434 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6240
Practice Address - Country:US
Practice Address - Phone:256-413-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist