Provider Demographics
NPI:1164245387
Name:STEVENS, MARY PAULA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:PAULA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:ASTOR
Mailing Address - State:FL
Mailing Address - Zip Code:32102-7947
Mailing Address - Country:US
Mailing Address - Phone:407-247-9144
Mailing Address - Fax:
Practice Address - Street 1:100 TECHNOLOGY PARK STE 155
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6205
Practice Address - Country:US
Practice Address - Phone:407-247-9144
Practice Address - Fax:866-842-1509
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS398961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist