Provider Demographics
NPI:1649392929
Name:BECKNER, STEPHEN DOUGLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:BECKNER
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 1:6516 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-8921
Mailing Address - Country:US
Mailing Address - Phone:269-323-2828
Mailing Address - Fax:
Practice Address - Street 1:714 SHOPPERS LN
Practice Address - Street 2:
Practice Address - City:PARCHMENT
Practice Address - State:MI
Practice Address - Zip Code:49004-1118
Practice Address - Country:US
Practice Address - Phone:269-349-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist