Active NPI
Russell G Stevenson Jr., BS, MA, RPH
- Pharmacist
- Peoria, AZ
National Provider Identifier
1992082374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S12743
- Practice address
- 6942 W Olive Ave Lot 67
Peoria, AZ 85345-7266 - Phone
- (602) 832-4269
- NPI assigned
- Nov 13, 2011
- Last updated
- Oct 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S12743 | AZ | Primary |
Addresses
Primary practice location
6942 W Olive Ave Lot 67
Peoria, AZ 85345-7266
Mailing address
6942 W Olive Ave Lot 67
Peoria, AZ 85345-7266
Phone (602) 832-4269
Other practice location 1
1601 N Park Dr
Winslow, AZ 86047-2559
Phone (928) 289-4615
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
- Credentials
- Bachelor of Science, Master of Arts, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S12743 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508976000000",
"number": "1992082374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6942 W OLIVE AVE LOT 67",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853457266",
"telephone_number": "602-832-4269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6942 W OLIVE AVE LOT 67",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853457266",
"telephone_number": "602-832-4269"
}
],
"practiceLocations": [
{
"address_1": "1601 N Park Dr",
"address_purpose": "LOCATION",
"city": "Winslow",
"state": "AZ",
"postal_code": "860472559",
"country_code": "US",
"telephone_number": "928-289-4615",
"fax_number": "928-289-0634",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STEVENSON",
"first_name": "RUSSELL",
"middle_name": "G",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "BS, MA, RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-13",
"last_updated": "2017-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S12743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.