Basic Information
| Provider Information | |||||||||
| NPI: | 1386928687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 LINWOOD DR | ||||||||
| Address2: | |||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724506122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702369756 | ||||||||
| FaxNumber: | 8702369356 | ||||||||
| Practice Location | |||||||||
| Address1: | 2420 LINWOOD DR | ||||||||
| Address2: | |||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724506122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702369756 | ||||||||
| FaxNumber: | 8702369356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 10/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 08092 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.