Healthcare Provider Details

I. General information

NPI: 1619268505
Provider Name (Legal Business Name): STEVEN TOMMY STAZNIK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ASHMUN ST
SAULT SAINTE MARIE MI
49783-2707
US

IV. Provider business mailing address

1025 ASHMUN ST
SAULT SAINTE MARIE MI
49783
US

V. Phone/Fax

Practice location:
  • Phone: 906-632-6874
  • Fax: 906-632-1849
Mailing address:
  • Phone: 906-632-6874
  • Fax: 906-632-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033448
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: