Provider Demographics
NPI:1538418546
Name:STEVENS-HOWELL VENTURE LLC
Entity type:Organization
Organization Name:STEVENS-HOWELL VENTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:618-781-3985
Mailing Address - Street 1:447 S BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2064
Mailing Address - Country:US
Mailing Address - Phone:618-655-0106
Mailing Address - Fax:618-655-0206
Practice Address - Street 1:447 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2064
Practice Address - Country:US
Practice Address - Phone:618-655-0106
Practice Address - Fax:618-655-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0180733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487342OtherNCPDP PROVIDER IDENTIFICATION NUMBER