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General NPI Number Information
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NPI Number | 1962858738
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Entity Type | Organization
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Legal Business Name | STEVENSON INVESTMENT GROUP, LLC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 204 W AVENUE J
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City | LANCASTER
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State | CA
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Zip | 93534-3684
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Country | US
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Telephone | 661-945-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 204 W AVENUE J
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City | LANCASTER
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State | CA
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Zip | 93534-3684
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Country | US
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Telephone | 661-945-0288
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Fax |
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | MARK S LIMON
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Credential |
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Telephone | 661-945-0288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 54423
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License Number State | CA
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