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General NPI Number Information
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NPI Number | 1093726630
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Entity Type | Organization
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Legal Business Name | STEPHENS PHARMACY INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 1100 S SPRINGFIELD AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-2512
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Country | US
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Telephone | 417-326-2416
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Fax | 417-326-6625
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Provider Business Mailing Address
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Address Line | 1100 S SPRINGFIELD AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-2512
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Country | US
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Telephone | 417-326-2416
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Fax | 417-326-6625
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Authorized Official
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Title or Position | PHARMACY OWNER
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Name | MICHEAL STEPHENS
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Credential | RPH
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Telephone | 417-326-2416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 006309
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License Number State | MO
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