Provider Demographics
NPI:1427745678
Name:STEPHENSON, LORI BETH (RPH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 TOWNE LAKE HLS N
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8191
Mailing Address - Country:US
Mailing Address - Phone:770-924-1334
Mailing Address - Fax:
Practice Address - Street 1:1605 ROBERTA DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-3855
Practice Address - Country:US
Practice Address - Phone:770-419-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist