Provider Demographics
NPI:1700101664
Name:STEPHENS, JONATHAN F (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:F
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:BS PHARMACY
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 677
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-0677
Mailing Address - Country:US
Mailing Address - Phone:334-983-4191
Mailing Address - Fax:334-983-5178
Practice Address - Street 1:15073 S US HWY 231
Practice Address - Street 2:
Practice Address - City:MIDLAND CITY
Practice Address - State:AL
Practice Address - Zip Code:36350
Practice Address - Country:US
Practice Address - Phone:334-983-4191
Practice Address - Fax:334-983-5178
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist