Healthcare Provider Details

I. General information

NPI: 1306458179
Provider Name (Legal Business Name): STEVEN ANDREW CROSS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 HIGHWAY 90 STE 300
PACE FL
32571-1098
US

IV. Provider business mailing address

2355 W MICHIGAN AVE APT A8
PENSACOLA FL
32526-2361
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-5510
  • Fax:
Mailing address:
  • Phone: 423-231-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53612
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: