Provider Demographics
NPI:1285181826
Name:DITTERT, STEVEN D (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:DITTERT
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:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538-0294
Mailing Address - Country:US
Mailing Address - Phone:615-513-5937
Mailing Address - Fax:
Practice Address - Street 1:846 NE 54TH TERRACE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:FL
Practice Address - Zip Code:33521
Practice Address - Country:US
Practice Address - Phone:352-689-5212
Practice Address - Fax:352-689-5293
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28808183500000X
SC8431183500000X
TN21462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist