MEDICARE: STEPHAN IVAN JURIK PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302413419	MI

General Provider Information

NPI Number	:	1700408382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN IVAN JURIK PHARMD

Provider Business Mailing Address
First Line	:	1675 LEAHY ST STE 111
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5538
Country	:	US
Telephone Number	:	231-672-7864
Fax Number	:	231-672-6485

Provider Business Practice Location Address
First Line	:	1675 LEAHY ST STE 111
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5538
Country	:	US
Telephone Number	:	231-672-7864
Fax Number	:	231-672-6485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	02/13/2024

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Directions to “ STEPHAN IVAN JURIK PHARMD” Practice Location

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