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General NPI Number Information
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NPI Number | 1972232247
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Entity Type | Individual
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Provider Name | NICHOLAS SHAWN STEVENSON
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 101 W EHRINGHAUS ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-4921
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Country | US
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Telephone | 252-338-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 100 ASHLEY DR
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-9153
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Country | US
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Telephone | 252-333-6905
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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 | 06707
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License Number State | NC
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