Provider Demographics
NPI:1881961159
Name:STEP, SEAN M (RPH)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:STEP
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 1:212 S LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4595
Mailing Address - Country:US
Mailing Address - Phone:217-235-3126
Mailing Address - Fax:217-234-3675
Practice Address - Street 1:212 S LOGAN AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4595
Practice Address - Country:US
Practice Address - Phone:217-235-3126
Practice Address - Fax:217-234-3675
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-286236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist