Provider Demographics
NPI:1447527247
Name:HALLER, STEVEN MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:HALLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:M
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3900 STOCKTON HILL RD # B-315
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3029
Mailing Address - Country:US
Mailing Address - Phone:928-692-7681
Mailing Address - Fax:928-704-5075
Practice Address - Street 1:3699 HWY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-0000
Practice Address - Country:US
Practice Address - Phone:928-704-5065
Practice Address - Fax:928-704-5075
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist