Organization
STEPHENS HEALTH CARE SPECIALISTS PLLC
Active
Other names
CHEYENNE PROFESSIONAL DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN STEPHENS (OWNER)
(580) 497-3325
Entity
Organization
Contact information
Practice address
413 BROADWAY, CHEYENNE, OK 73628
(580) 497-3325
(580) 497-3326
Mailing address
PO BOX 860, CHEYENNE, OK 73628-0860
(580) 497-3325
(580) 497-3326
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
765469
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3704182
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/07/2006
Last updated
11/05/2009
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