Provider Demographics
NPI:1790087088
Name:LYFORD, STEVEN MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:LYFORD
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 1:110 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-1820
Mailing Address - Country:US
Mailing Address - Phone:906-486-4405
Mailing Address - Fax:906-486-4406
Practice Address - Street 1:110 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1820
Practice Address - Country:US
Practice Address - Phone:906-486-4405
Practice Address - Fax:906-486-4406
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist