Provider Demographics
NPI:1548697055
Name:STEVENS, IAN G (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:G
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5620
Mailing Address - Country:US
Mailing Address - Phone:541-754-5583
Mailing Address - Fax:541-754-5577
Practice Address - Street 1:777 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5620
Practice Address - Country:US
Practice Address - Phone:541-754-5583
Practice Address - Fax:541-754-5577
Is Sole Proprietor?:No
Enumeration Date:2013-09-28
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013804183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist