Provider Demographics
NPI:1992960132
Name:NELSON, STEVEN KIRK (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:KIRK
Last Name:NELSON
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 1:1813 GRAHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:OR
Mailing Address - Zip Code:97918-5351
Mailing Address - Country:US
Mailing Address - Phone:541-473-2930
Mailing Address - Fax:
Practice Address - Street 1:2283 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1849
Practice Address - Country:US
Practice Address - Phone:541-889-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008452-P183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH0008452-POtherOREGON BOARD OF PHARMACY LICENSE