Healthcare Provider Details

I. General information

NPI: 1982987442
Provider Name (Legal Business Name): STEVEN EUGENE SHIVELY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 N CASS ST
WABASH IN
46992-2443
US

IV. Provider business mailing address

487 N CASS ST
WABASH IN
46992-2443
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-3183
  • Fax: 260-563-8750
Mailing address:
  • Phone: 260-563-3183
  • Fax: 260-563-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26014139A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: