Provider Demographics
NPI:1659030385
Name:JUSTICE, STEVEN ERIC
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ERIC
Last Name:JUSTICE
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 1:2508 CRANFIELD RD SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9396
Mailing Address - Country:US
Mailing Address - Phone:256-366-5270
Mailing Address - Fax:
Practice Address - Street 1:4100 GOSS RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35809-0001
Practice Address - Country:US
Practice Address - Phone:256-876-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist