Provider Demographics
NPI:1154617330
Name:DICK, STEVEN (CPHT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:DICK
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 NAMEOKI RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3714
Mailing Address - Country:US
Mailing Address - Phone:618-877-6880
Mailing Address - Fax:618-877-2012
Practice Address - Street 1:3732 NAMEOKI RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3714
Practice Address - Country:US
Practice Address - Phone:618-877-6880
Practice Address - Fax:618-877-2012
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.163014183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician