Healthcare Provider Details

I. General information

NPI: 1649392929
Provider Name (Legal Business Name): STEPHEN DOUGLAS BECKNER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 SHOPPERS LN
PARCHMENT MI
49004-1118
US

IV. Provider business mailing address

6516 SUSSEX ST
PORTAGE MI
49024-8921
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-7322
  • Fax:
Mailing address:
  • Phone: 269-323-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026102
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: