Provider Demographics
NPI:1730315763
Name:STEED, MATTHEW RHOADES (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RHOADES
Last Name:STEED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 BROADWAY ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-2542
Mailing Address - Country:US
Mailing Address - Phone:607-732-2006
Mailing Address - Fax:607-732-2117
Practice Address - Street 1:1141 BROADWAY ST
Practice Address - Street 2:SUITE 8
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-2542
Practice Address - Country:US
Practice Address - Phone:607-732-2006
Practice Address - Fax:607-732-2117
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02745540Medicaid