Active NPI
Kenric Lamar Stephens, PHARMACIST
- Pharmacist
- Andrews Air Force Base, MD
National Provider Identifier
1740373638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17177
- Practice address
- 1050 W Perimeter Rd
79TH MDSS/SGSP
Andrews Air Force Base, MD 20762-6601 - Phone
- (240) 857-3689
- Fax
- (240) 854-4544
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS18999 | FL | |
| Pharmacist | 183500000X | 17177 | MD | Primary |
Addresses
Primary practice location
1050 W Perimeter Rd
79TH MDSS/SGSP
Andrews Air Force Base, MD 20762-6601
Mailing address
4611 Sharon Rd
Camp Springs, MD 20748-3737
Phone (301) 702-3016
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17177 | MD | MD | Clinical Social Worker |
| PS18999 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740373638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4611 SHARON RD",
"city": "CAMP SPRINGS",
"state": "MD",
"postal_code": "207483737",
"telephone_number": "301-702-3016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 W PERIMETER RD",
"address_2": "79TH MDSS/SGSP",
"city": "ANDREWS AIR FORCE BASE",
"state": "MD",
"postal_code": "207626601",
"telephone_number": "240-857-3689",
"fax_number": "240-854-4544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHENS",
"first_name": "KENRIC",
"middle_name": "LAMAR",
"name_prefix": "Mr.",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS18999",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "17177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andrews Air Force Base, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.