Provider Demographics
NPI:1700408382
Name:JURIK, STEPHAN IVAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:IVAN
Last Name:JURIK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 LEAHY ST STE 111
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5538
Mailing Address - Country:US
Mailing Address - Phone:231-672-7864
Mailing Address - Fax:231-672-6485
Practice Address - Street 1:1675 LEAHY ST STE 111
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5538
Practice Address - Country:US
Practice Address - Phone:231-672-7864
Practice Address - Fax:231-672-6485
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist