Provider Demographics
NPI:1205666484
Name:STEWART, ALEXIS MARIE (CPHT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 PATTEN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-2530
Mailing Address - Country:US
Mailing Address - Phone:740-396-4964
Mailing Address - Fax:
Practice Address - Street 1:1546 MARION MOUNT GILEAD RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5894
Practice Address - Country:US
Practice Address - Phone:740-389-4573
Practice Address - Fax:740-389-4579
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09319108183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician