Healthcare Provider Details

I. General information

NPI: 1417960865
Provider Name (Legal Business Name): JAMES T. STEPHENS III RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SCHNEIDMAN RD
PADUCAH KY
42003-3541
US

IV. Provider business mailing address

5375 CLINTON RD
PADUCAH KY
42001-9239
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-7200
  • Fax: 270-443-8537
Mailing address:
  • Phone: 270-443-7200
  • Fax: 270-443-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7577
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: