Organization
STEVENS-HOWELL VENTURE LLC
Active
Other names
Howell Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CLAYTON STEVENS PHARMD (MANAGER)
(618) 781-3985
Entity
Organization
Contact information
Practice address
447 S BUCHANAN ST, EDWARDSVILLE, IL 62025-2064
(618) 655-0106
(618) 655-0206
Mailing address
447 S BUCHANAN ST, EDWARDSVILLE, IL 62025-2064
(618) 655-0106
(618) 655-0206
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054.018073
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487342
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/05/2012
Last updated
01/09/2013
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