Provider Demographics
NPI:1942800438
Name:STEVENS, ANDREW PAUL
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
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 1:201 US HIGHWAY 59 LOOP
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-2011
Mailing Address - Country:US
Mailing Address - Phone:903-490-0490
Mailing Address - Fax:
Practice Address - Street 1:201 US HIGHWAY 59 LOOP
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-2011
Practice Address - Country:US
Practice Address - Phone:903-490-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist