Provider Demographics
NPI:1871588038
Name:STEPHENSON, DAVID W (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3720
Mailing Address - Country:US
Mailing Address - Phone:757-484-9534
Mailing Address - Fax:
Practice Address - Street 1:3701 KING ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3115
Practice Address - Country:US
Practice Address - Phone:757-397-2377
Practice Address - Fax:757-399-2013
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist