Provider Demographics
NPI:1912508920
Name:STEVENS, KERRY DON (PHARMD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DON
Last Name:STEVENS
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:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:MARMADUKE
Mailing Address - State:AR
Mailing Address - Zip Code:72443-0422
Mailing Address - Country:US
Mailing Address - Phone:870-239-1716
Mailing Address - Fax:
Practice Address - Street 1:4763 HIGHWAY 135 N
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-9085
Practice Address - Country:US
Practice Address - Phone:870-586-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist