Provider Demographics
NPI:1447563382
Name:PETNER, STEVEN P (RPH,CIP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:PETNER
Suffix:
Gender:M
Credentials:RPH,CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WALLACE AVE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2604
Mailing Address - Country:US
Mailing Address - Phone:610-873-4725
Mailing Address - Fax:610-518-1587
Practice Address - Street 1:101 WALLACE AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2604
Practice Address - Country:US
Practice Address - Phone:610-873-4725
Practice Address - Fax:610-518-1587
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025025L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist