Provider Demographics
NPI:1093712051
Name:NELSON, STEVEN DAVID (RPH / CPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DAVID
Last Name:NELSON
Suffix:
Gender:M
Credentials:RPH / CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SW PARK ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-4160
Mailing Address - Country:US
Mailing Address - Phone:863-763-5100
Mailing Address - Fax:863-763-8856
Practice Address - Street 1:203 SW PARK ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4160
Practice Address - Country:US
Practice Address - Phone:863-763-5100
Practice Address - Fax:863-763-8856
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU2525183500000X
FLPS15185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist