Provider Demographics
NPI:1780921676
Name:STEPHENS, KIMBERLY SUSANNE (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUSANNE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3858
Mailing Address - Country:US
Mailing Address - Phone:863-686-4241
Mailing Address - Fax:863-687-0049
Practice Address - Street 1:2515 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3858
Practice Address - Country:US
Practice Address - Phone:863-686-4241
Practice Address - Fax:863-687-0049
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0032736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist