Provider Demographics
NPI:1124756119
Name:VICKERY, STEPHEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:VICKERY
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SQUIRREL TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-8200
Mailing Address - Country:US
Mailing Address - Phone:410-980-1346
Mailing Address - Fax:
Practice Address - Street 1:705 6TH AVE W STE D
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4161
Practice Address - Country:US
Practice Address - Phone:828-694-8422
Practice Address - Fax:828-694-8423
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22682183500000X
NC7004051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist