Provider Demographics
NPI:1972805331
Name:STEED, GERALD K (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:K
Last Name:STEED
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 1:596 EAGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440
Mailing Address - Country:US
Mailing Address - Phone:208-656-0156
Mailing Address - Fax:
Practice Address - Street 1:596 EAGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:REXBURY
Practice Address - State:ID
Practice Address - Zip Code:83440
Practice Address - Country:US
Practice Address - Phone:208-656-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1243183500000X
IDP4248183500000X
MT4963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist