Provider Demographics
NPI:1760595987
Name:CULL, STEVEN MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MATTHEW
Last Name:CULL
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 1:102 KELLY CT
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-3100
Mailing Address - Country:US
Mailing Address - Phone:502-484-3611
Mailing Address - Fax:502-484-0141
Practice Address - Street 1:327 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-1409
Practice Address - Country:US
Practice Address - Phone:502-484-3113
Practice Address - Fax:502-484-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist