Provider Demographics
NPI:1194873612
Name:STEPHENS, CHARLES E (DPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LEXINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:615-449-7399
Mailing Address - Fax:615-449-7033
Practice Address - Street 1:323 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-449-7399
Practice Address - Fax:615-449-7033
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4978530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist