1588188452 NPI number — DR. KARMEN LEE ANN STEPHENS PHARM.D., BCGP

Table of content: ADRIA L EDENFIELD II PA (NPI 1629012182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588188452 NPI number — DR. KARMEN LEE ANN STEPHENS PHARM.D., BCGP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENS
Provider First Name:
KARMEN
Provider Middle Name:
LEE ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D., BCGP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSTER
Provider Other First Name:
KARMEN
Provider Other Middle Name:
LEE ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588188452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 E ARAPAHO RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75081-2362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-444-8840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 E ARAPAHO RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-676-8382
Provider Business Practice Location Address Fax Number:
214-614-4740
Provider Enumeration Date:
08/01/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835G0303X , with the licence number:  9107215 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 48764 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124015 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 17417 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 48764 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0202217182 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20723-40 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: RP453101 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 051301645 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2012036677 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".