Provider Demographics
NPI:1730445537
Name:CRIDER, STEVEN CLARENCE (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CLARENCE
Last Name:CRIDER
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 1:3116 METOLIUS DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408
Mailing Address - Country:US
Mailing Address - Phone:503-580-6530
Mailing Address - Fax:
Practice Address - Street 1:3740 MARKET ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-580-6530
Practice Address - Fax:503-945-0844
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 000136183500000X
ORRPH-001475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist