Provider Demographics
NPI:1982207833
Name:STEPHENSON, MICHELLE E (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8928
Mailing Address - Country:US
Mailing Address - Phone:078-833-6172
Mailing Address - Fax:
Practice Address - Street 1:440 PAYNE RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8928
Practice Address - Country:US
Practice Address - Phone:207-883-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEADV69790183500000X
MEPR69488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist