Provider Demographics
NPI:1689887309
Name:KANIS, STEVEN PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PAUL
Last Name:KANIS
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 1:1635 HIGHWAY KK
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3361
Mailing Address - Country:US
Mailing Address - Phone:573-348-4067
Mailing Address - Fax:
Practice Address - Street 1:1635 HIGHWAY KK
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3361
Practice Address - Country:US
Practice Address - Phone:573-348-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO40231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist