Provider Demographics
NPI:1528390465
Name:BLICK, STEVEN (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BLICK
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 1:1727 SEAGIRT BLVD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4513
Mailing Address - Country:US
Mailing Address - Phone:718-471-2500
Mailing Address - Fax:718-471-0840
Practice Address - Street 1:1727 SEAGIRT BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4513
Practice Address - Country:US
Practice Address - Phone:718-471-2500
Practice Address - Fax:718-471-0840
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035892-1183500000X
VA0202005220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202005220OtherPHARMACIST LIC.
NY035892-1OtherPHARMACIST LIC.