Provider Demographics
NPI:1912500703
Name:STEWART, SAMUEL EVAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EVAN
Last Name:STEWART
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 1:2124 CHESHIRE BRIDGE RD NE APT 5212
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5724
Mailing Address - Country:US
Mailing Address - Phone:662-587-6199
Mailing Address - Fax:
Practice Address - Street 1:129 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2304
Practice Address - Country:US
Practice Address - Phone:770-479-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty