Provider Demographics
NPI:1447872353
Name:STEVERS, REBECCA ANN (CPHT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:STEVERS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 FARMDALE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1850
Mailing Address - Country:US
Mailing Address - Phone:219-405-0675
Mailing Address - Fax:
Practice Address - Street 1:3805 FARMDALE DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-1850
Practice Address - Country:US
Practice Address - Phone:219-405-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67026160A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30114088OtherPTCB
IN67026160AOtherPHARMACY BOARD