Provider Demographics
NPI:1932861853
Name:STEPHENS, BOBBIE (PST024041)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PST024041
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 HIGHWAY 585
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-8222
Mailing Address - Country:US
Mailing Address - Phone:318-669-0740
Mailing Address - Fax:
Practice Address - Street 1:302 LAKE STREET
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-7125
Practice Address - Country:US
Practice Address - Phone:318-559-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist