Healthcare Provider Details

I. General information

NPI: 1205962073
Provider Name (Legal Business Name): STEPHENS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WILLIAM HILTON PKWY SUITE 302 B
HILTON HEAD ISLAND SC
29926-2424
US

IV. Provider business mailing address

430 WILLIAM HILTON PKWY SUITE 302 B
HILTON HEAD ISLAND SC
29926-2424
US

V. Phone/Fax

Practice location:
  • Phone: 843-686-3735
  • Fax: 843-686-3035
Mailing address:
  • Phone: 843-686-3735
  • Fax: 843-686-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50006936
License Number StateSC

VIII. Authorized Official

Name: MR. JERRY STEPHENS
Title or Position: PRESIDENT
Credential:
Phone: 843-686-3735