Provider Demographics
NPI:1598814162
Name:STEWART, DEBORAH W (BS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:W
Last Name:STEWART
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SHEPHARD RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-6239
Mailing Address - Country:US
Mailing Address - Phone:423-975-6499
Mailing Address - Fax:
Practice Address - Street 1:1107 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3901
Practice Address - Country:US
Practice Address - Phone:423-926-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist