Provider Demographics
NPI:1275662769
Name:BROUDY, STEVEN LEE
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEE
Last Name:BROUDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907B ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-2022
Mailing Address - Country:US
Mailing Address - Phone:757-473-2737
Mailing Address - Fax:800-359-5781
Practice Address - Street 1:5832 MIDTOWNE WAY
Practice Address - Street 2:SUPPORT CENTER 1
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5143
Practice Address - Country:US
Practice Address - Phone:757-473-2737
Practice Address - Fax:800-359-5781
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist