Provider Demographics
NPI:1710149703
Name:STEPHENS, MARK ALAN (PHARMDL)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PHARMDL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 UNION UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3656
Mailing Address - Country:US
Mailing Address - Phone:731-661-5975
Mailing Address - Fax:731-661-5980
Practice Address - Street 1:1050 UNION UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3656
Practice Address - Country:US
Practice Address - Phone:731-661-5975
Practice Address - Fax:731-661-5980
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65881835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy