Provider Demographics
NPI:1952416885
Name:STEPP, ANDREW (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:STEPP
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:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-0656
Mailing Address - Country:US
Mailing Address - Phone:662-983-4011
Mailing Address - Fax:662-983-4072
Practice Address - Street 1:203 N NEWBERGER AVE
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-9430
Practice Address - Country:US
Practice Address - Phone:662-983-4011
Practice Address - Fax:662-983-4072
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE06925OtherMS PHARMACIST LICENSE
MS01773/01.1OtherPHARMACY LICENSE