Basic Information
| Provider Information | |||||||||
| NPI: | 1851506729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHEN | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1132 TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404545666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15 N MAYSVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437016110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404533700 | ||||||||
| FaxNumber: | 7404533737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2007 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03-2-21411 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.