Individual
TYLER ALLEN STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
201 1ST STREET SOUTH, NAMPA, ID 83651
(208) 466-7869
Mailing address
1019 W MAIN ST, BOISE, ID 83702-6188
(908) 809-2412
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
P9462
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P9462
—
ID
Enumeration date
12/21/2021
Last updated
12/21/2021
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