Healthcare Provider Details

I. General information

NPI: 1154922748
Provider Name (Legal Business Name): TAMICA N STEPHENS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 E MADISON ST
HOUSTON MS
38851-2411
US

IV. Provider business mailing address

660 E MADISON ST
HOUSTON MS
38851-2411
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-9244
  • Fax: 662-456-4441
Mailing address:
  • Phone: 662-456-9244
  • Fax: 662-456-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-010614
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: