Provider Demographics
NPI:1982613899
Name:STEVERSON, WILLIAM L (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:STEVERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-2471
Mailing Address - Country:US
Mailing Address - Phone:850-638-4875
Mailing Address - Fax:850-638-9195
Practice Address - Street 1:1242 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-2471
Practice Address - Country:US
Practice Address - Phone:850-638-4875
Practice Address - Fax:850-638-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS21104OtherPHARMACIST LICENSE NUMBER