Provider Demographics
NPI:1376824144
Name:HOOPER, STEVEN JOHN
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOHN
Last Name:HOOPER
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 1:160 ELLENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01128-1122
Mailing Address - Country:US
Mailing Address - Phone:413-783-0137
Mailing Address - Fax:
Practice Address - Street 1:160 ELLENDALE CIR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1122
Practice Address - Country:US
Practice Address - Phone:413-783-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist