Healthcare Provider Details

I. General information

NPI: 1619514874
Provider Name (Legal Business Name): JUNE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HIGHWAY 199
SPRINGTOWN TX
76082-2755
US

IV. Provider business mailing address

PO BOX 803
SPRINGTOWN TX
76082-0803
US

V. Phone/Fax

Practice location:
  • Phone: 817-220-1178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: