Provider Demographics
NPI:1659952257
Name:STEVENS, CHRIS BRYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:BRYAN
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 1:428 MAONO LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2525
Mailing Address - Country:US
Mailing Address - Phone:803-429-8554
Mailing Address - Fax:
Practice Address - Street 1:3375 KOAPAKA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1800
Practice Address - Country:US
Practice Address - Phone:808-222-0537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-25641835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric