=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487997524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. SHERIN STEPHEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2013
-----------------------------------------------------
Last Update Date | 03/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2011 NW 3RD AVE
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33060-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-786-5914
-----------------------------------------------------
Fax | 954-786-0129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2011 NW 3RD AVE
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-786-5914
-----------------------------------------------------
Fax | 954-786-0129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS39467
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------