Provider Demographics
NPI:1902175912
Name:STOVER, MITZI J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MITZI
Middle Name:J
Last Name:STOVER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 PEBBLE CREEK CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7126
Mailing Address - Country:US
Mailing Address - Phone:901-850-9361
Mailing Address - Fax:
Practice Address - Street 1:7650 W FARMINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2827
Practice Address - Country:US
Practice Address - Phone:901-754-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist