Provider Demographics
NPI:1386244614
Name:STEINKAMP, JASON KENNETH (RPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:KENNETH
Last Name:STEINKAMP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 ABBOTT ST
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-1162
Mailing Address - Country:US
Mailing Address - Phone:618-541-9802
Mailing Address - Fax:
Practice Address - Street 1:1870 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-5872
Practice Address - Country:US
Practice Address - Phone:618-548-3691
Practice Address - Fax:618-548-3691
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-041184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist