Provider Demographics
NPI:1750665956
Name:STEPHENSON, DEJA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEJA
Middle Name:MARIE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419
Mailing Address - Country:US
Mailing Address - Phone:912-927-6119
Mailing Address - Fax:912-925-5456
Practice Address - Street 1:11505 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-927-6119
Practice Address - Fax:912-925-5456
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025684183500000X
SCPH.13153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist