Provider Demographics
NPI:1861040719
Name:STEVENS, LAWSON TYLER
Entity Type:Individual
Prefix:
First Name:LAWSON
Middle Name:TYLER
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 GRANDISON WAY
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2142
Mailing Address - Country:US
Mailing Address - Phone:443-765-0294
Mailing Address - Fax:
Practice Address - Street 1:28 MAGOTHY BEACH RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4428
Practice Address - Country:US
Practice Address - Phone:410-437-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist