Individual
MRS. REGINA STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2100 12TH AVE RD, NAMPA, ID 83686-6441
(208) 467-5159
Mailing address
1101 N C ST, PO BOX 420, PARMA, ID 83660-5539
(208) 722-6073
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5209
ID
Other
Enumeration date
08/05/2014
Last updated
08/05/2014
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