Healthcare Provider Details

I. General information

NPI: 1548573900
Provider Name (Legal Business Name): STEPHENS COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 843-686-3040
  • Fax: 843-686-3035
Mailing address:
  • Phone: 843-686-3040
  • Fax: 843-686-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number10748
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SHEILA M STEPHENS
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 843-686-3040