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General NPI Number Information
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NPI Number | 1104045657
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Entity Type | Individual
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Provider Name | RANDY CORNELIOUS STEPHENS R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 5007 WESTERDALE DR
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City | FULSHEAR
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State | TX
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Zip | 77441-4216
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Country | US
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Telephone | 281-533-9497
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Fax |
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Provider Business Mailing Address
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Address Line | 5007 WESTERDALE DR
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City | FULSHEAR
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State | TX
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Zip | 77441-4216
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Country | US
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Telephone | 281-533-9497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24638
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9851
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7400
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License Number State | AZ
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