Healthcare Provider Details

I. General information

NPI: 1619027018
Provider Name (Legal Business Name): WILLIAM TAYLOR STEPHENS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OUTER DR
DETROIT MI
48235-3461
US

IV. Provider business mailing address

15500 ASHTON RD
DETROIT MI
48223-1376
US

V. Phone/Fax

Practice location:
  • Phone: 313-653-2039
  • Fax: 313-255-2091
Mailing address:
  • Phone: 313-493-0979
  • Fax: 313-255-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302020911
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: