Provider Demographics
NPI:1861866444
Name:STEVENS, MATTHEW PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PATRICK
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2624
Mailing Address - Country:US
Mailing Address - Phone:916-373-6042
Mailing Address - Fax:916-373-6474
Practice Address - Street 1:1363 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5495
Practice Address - Country:US
Practice Address - Phone:775-782-2226
Practice Address - Fax:775-782-1007
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist