Provider Demographics
NPI:1912500703
Name:STEWART, SAMUEL EVAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EVAN
Last Name:STEWART
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 1:11 COUNTY ROAD 770
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:MS
Mailing Address - Zip Code:38683-9262
Mailing Address - Country:US
Mailing Address - Phone:662-587-6199
Mailing Address - Fax:
Practice Address - Street 1:104 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5511
Practice Address - Country:US
Practice Address - Phone:662-287-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0293511835P0018X
MST-1020571835P0018X
TN492761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty