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General NPI Number Information
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NPI Number | 1770898660
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Entity Type | Individual
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Provider Name | STEVEN F GORMAN-HACKSTADT RPH
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Gender | Male
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 5160 S WHITE MOUNTAIN RD
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City | SHOW LOW
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State | AZ
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Zip | 85901-7826
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Country | US
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Telephone | 928-532-5502
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Fax | 928-532-5499
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Provider Business Mailing Address
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Address Line | 1541 N BLUE GRASS RANCH DR
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City | LAKESIDE
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State | AZ
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Zip | 85929-9776
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Country | US
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Telephone | 928-367-6177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 007832
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License Number State | AZ
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