MEDICARE: DR. STEPHEN ALAN PERSONS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S019536	AZ
2	183500000X	Pharmacist	28RI03661800	NJ
3	183500000X	Pharmacist	19323	AL
4	183500000X	Pharmacist	PD13607	AR
5	183500000X	Pharmacist	P7546	ID
6	183500000X	Pharmacist	18674	KY
7	183500000X	Pharmacist	PST.021622	LA
8	183500000X	Pharmacist	24176	MD
9	183500000X	Pharmacist	5302044633	MI
10	183500000X	Pharmacist	T-14463	MS
11	183500000X	Pharmacist	15441	NE
12	183500000X	Pharmacist	19375	NV
13	183500000X	Pharmacist	062024-1	NY
14	183500000X	Pharmacist	16945	OK
15	183500000X	Pharmacist	RPH-0015418	OR

General Provider Information

NPI Number	:	1720470941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ALAN PERSONS PHARMD

Provider Business Mailing Address
First Line	:	2320 W PEORIA AVE
Second Line	:	SUITE D-132
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4753
Country	:	US
Telephone Number	:	602-678-5400
Fax Number	:	602-678-5401

Provider Business Practice Location Address
First Line	:	2320 W PEORIA AVE
Second Line	:	SUITE D-132
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4753
Country	:	US
Telephone Number	:	602-678-5400
Fax Number	:	602-678-5401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	09/15/2016

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