Provider Demographics
NPI:1952652752
Name:STEVENSON, MARK BRENT (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRENT
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 BYPASS 72 NW STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1405
Mailing Address - Country:US
Mailing Address - Phone:864-223-8909
Mailing Address - Fax:864-538-6489
Practice Address - Street 1:479 BYPASS 72 NW STE 100
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1405
Practice Address - Country:US
Practice Address - Phone:864-223-8909
Practice Address - Fax:864-538-6489
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist