Provider Demographics
NPI:1598085573
Name:DIAZ, STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:DIAZ
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 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-2096
Mailing Address - Country:US
Mailing Address - Phone:732-369-6081
Mailing Address - Fax:732-369-6081
Practice Address - Street 1:303 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-2096
Practice Address - Country:US
Practice Address - Phone:732-369-6081
Practice Address - Fax:732-369-6081
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02117000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist