Provider Demographics
NPI:1982987442
Name:SHIVELY, STEVEN EUGENE (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:EUGENE
Last Name:SHIVELY
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 1:487 N CASS ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-2443
Mailing Address - Country:US
Mailing Address - Phone:260-563-3183
Mailing Address - Fax:260-563-8750
Practice Address - Street 1:487 N CASS ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-2443
Practice Address - Country:US
Practice Address - Phone:260-563-3183
Practice Address - Fax:260-563-8750
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014139A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist