Provider Demographics
NPI:1891229514
Name:STEVENS, ANDREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 2
Mailing Address - Street 2:BOX 12399
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0124
Mailing Address - Country:US
Mailing Address - Phone:491525-397-5251
Mailing Address - Fax:
Practice Address - Street 1:PSC 2 BOX 12399
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09012-0124
Practice Address - Country:US
Practice Address - Phone:491525-397-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist