Provider Demographics
NPI:1932255841
Name:MYERS, STEPHEN LUKE (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LUKE
Last Name:MYERS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 AMERINE RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3562
Mailing Address - Country:US
Mailing Address - Phone:865-983-6579
Mailing Address - Fax:
Practice Address - Street 1:1536 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3202
Practice Address - Country:US
Practice Address - Phone:865-982-3020
Practice Address - Fax:865-977-6698
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist