Provider Demographics
NPI:1578243598
Name:STEFFEN, JACK MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MATTHEW
Last Name:STEFFEN
Suffix:
Gender:M
Credentials:PHARMD
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 248
Mailing Address - Street 2:
Mailing Address - City:HARTINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68739-0248
Mailing Address - Country:US
Mailing Address - Phone:402-254-3549
Mailing Address - Fax:
Practice Address - Street 1:214 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HARTINGTON
Practice Address - State:NE
Practice Address - Zip Code:68739-4619
Practice Address - Country:US
Practice Address - Phone:402-254-3549
Practice Address - Fax:402-254-3545
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist