Provider Demographics
NPI:1649267865
Name:STEPHENS, CAROLYN KELLY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:KELLY
Last Name:STEPHENS
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:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-1236
Mailing Address - Country:US
Mailing Address - Phone:727-593-5288
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PHARMACY
Practice Address - Street 2:BAY PINES VAMC
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-5001
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist