Provider Demographics
NPI:1720470941
Name:PERSONS, STEPHEN ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:PERSONS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 W PEORIA AVE
Mailing Address - Street 2:SUITE D-132
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4753
Mailing Address - Country:US
Mailing Address - Phone:602-678-5400
Mailing Address - Fax:602-678-5401
Practice Address - Street 1:2320 W PEORIA AVE
Practice Address - Street 2:SUITE D-132
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4753
Practice Address - Country:US
Practice Address - Phone:602-678-5400
Practice Address - Fax:602-678-5401
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019536183500000X
NJ28RI03661800183500000X
AL19323183500000X
ARPD13607183500000X
IDP7546183500000X
KY18674183500000X
LAPST.021622183500000X
MD24176183500000X
MI5302044633183500000X
MST-14463183500000X
NE15441183500000X
NV19375183500000X
NY062024-1183500000X
OK16945183500000X
ORRPH-0015418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist