Provider Demographics
NPI:1063401586
Name:STEPHENS, CALVIN WELDON (RPH)
Entity type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:WELDON
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 TRENTON DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1619
Mailing Address - Country:US
Mailing Address - Phone:205-343-1657
Mailing Address - Fax:
Practice Address - Street 1:911 FAIRFAX PARK
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2805
Practice Address - Country:US
Practice Address - Phone:205-391-3636
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7641OtherSTATE LICENSE NUMBER