Provider Demographics
NPI:1023399466
Name:BECKERDITE, STEVEN KEITH (P D)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KEITH
Last Name:BECKERDITE
Suffix:
Gender:M
Credentials:P D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 N STARR DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2935
Mailing Address - Country:US
Mailing Address - Phone:479-442-2134
Mailing Address - Fax:479-442-2814
Practice Address - Street 1:2750 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3262
Practice Address - Country:US
Practice Address - Phone:479-442-2134
Practice Address - Fax:479-442-2814
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR07862183500000X
TX23483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist