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General NPI Number Information
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NPI Number | 1982995767
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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 | 04/27/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 1100 S SPRINGFIELD AVE STE A
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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 | 417-326-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 S SPRINGFIELD AVE SUITE A
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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 | 417-326-2570
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MICHAEL STEPHENS
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Credential |
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 2011008719
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License Number State | MO
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