Provider Demographics
NPI:1831427665
Name:STEPHENS, SHOMICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHOMICHAEL
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71049-0068
Mailing Address - Country:US
Mailing Address - Phone:318-697-4381
Mailing Address - Fax:318-697-5311
Practice Address - Street 1:204 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:LA
Practice Address - Zip Code:71049-2997
Practice Address - Country:US
Practice Address - Phone:318-697-4381
Practice Address - Fax:318-697-5311
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18428183500000X
TX41142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist