Provider Demographics
NPI:1649557414
Name:STEIN, IRA JOEL
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:JOEL
Last Name:STEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1143
Mailing Address - Country:US
Mailing Address - Phone:954-384-0011
Mailing Address - Fax:954-384-6212
Practice Address - Street 1:199 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1143
Practice Address - Country:US
Practice Address - Phone:954-384-0011
Practice Address - Fax:954-384-6212
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist