Provider Demographics
NPI:1336550789
Name:BECKER, STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:BECKER
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 1:5909 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1159
Mailing Address - Country:US
Mailing Address - Phone:260-434-3933
Mailing Address - Fax:260-434-3965
Practice Address - Street 1:5909 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1159
Practice Address - Country:US
Practice Address - Phone:260-434-3933
Practice Address - Fax:260-434-3965
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013000A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy