Healthcare Provider Details

I. General information

NPI: 1508438946
Provider Name (Legal Business Name): SAMUEL STEVENSON PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROADWAY STE BR114
SEATTLE WA
98122-5330
US

IV. Provider business mailing address

1105 SPRING ST APT 804
SEATTLE WA
98104-3516
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2218
  • Fax: 206-215-6417
Mailing address:
  • Phone: 913-271-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61065419
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: