Provider Demographics
NPI:1295024990
Name:COMO, STEVEN G SR
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:COMO
Suffix:SR
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 1:1640 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2162
Mailing Address - Country:US
Mailing Address - Phone:978-249-9132
Mailing Address - Fax:978-249-2867
Practice Address - Street 1:1640 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2162
Practice Address - Country:US
Practice Address - Phone:978-249-9132
Practice Address - Fax:978-249-2867
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23444183500000X
NH2775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist