Healthcare Provider Details

I. General information

NPI: 1407208374
Provider Name (Legal Business Name): CHRISTINE ALLISON STEVER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE SUITE 1830
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

2474 MCINTOSH AVE NE
GRAND RAPIDS MI
49525-3123
US

V. Phone/Fax

Practice location:
  • Phone: 616-249-6210
  • Fax: 616-249-6465
Mailing address:
  • Phone: 616-365-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302028504
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: