Provider Demographics
NPI:1699060186
Name:FINE, STEVEN MATTHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MATTHEW
Last Name:FINE
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 1:1883 WENTZVILLE PKWY
Mailing Address - Street 2:T-2345
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3896
Mailing Address - Country:US
Mailing Address - Phone:636-639-7434
Mailing Address - Fax:636-639-7444
Practice Address - Street 1:1883 WENTZVILLE PKWY
Practice Address - Street 2:T-2345
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3896
Practice Address - Country:US
Practice Address - Phone:636-639-7434
Practice Address - Fax:636-639-7444
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist