Provider Demographics
NPI:1023605060
Name:KUPER, STEVEN B (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:KUPER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8304
Mailing Address - Country:US
Mailing Address - Phone:817-456-4348
Mailing Address - Fax:
Practice Address - Street 1:3145 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5602
Practice Address - Country:US
Practice Address - Phone:817-453-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist