MEDICARE: MR. KENRIC LAMAR STEPHENS PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS18999	FL
2	183500000X	Pharmacist	17177	MD

General Provider Information

NPI Number	:	1740373638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENRIC LAMAR STEPHENS PHARMACIST

Provider Business Mailing Address
First Line	:	4611 SHARON RD
Second Line	:
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20748-3737
Country	:	US
Telephone Number	:	301-702-3016
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 W PERIMETER RD
Second Line	:	79TH MDSS/SGSP
City	:	ANDREWS AIR FORCE BASE
State	:	MD
Zip	:	20762-6601
Country	:	US
Telephone Number	:	240-857-3689
Fax Number	:	240-854-4544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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