MEDICARE: MR. STEVEN DAVID NELSON RPH / CPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PU2525	FL
2	183500000X	Pharmacist	PS15185	FL

General Provider Information

NPI Number	:	1093712051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN DAVID NELSON RPH / CPH

Provider Business Mailing Address
First Line	:	203 SW PARK ST
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-4160
Country	:	US
Telephone Number	:	863-763-5100
Fax Number	:	863-763-8856

Provider Business Practice Location Address
First Line	:	203 SW PARK ST
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-4160
Country	:	US
Telephone Number	:	863-763-5100
Fax Number	:	863-763-8856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	05/18/2012

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