Provider Demographics
NPI:1366755571
Name:BRODERSON, STEVEN (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:BRODERSON
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 1:64A PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JCT
Mailing Address - State:NJ
Mailing Address - Zip Code:08550
Mailing Address - Country:US
Mailing Address - Phone:609-799-4114
Mailing Address - Fax:609-799-3822
Practice Address - Street 1:64A PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON JCT
Practice Address - State:NJ
Practice Address - Zip Code:08550
Practice Address - Country:US
Practice Address - Phone:609-799-4114
Practice Address - Fax:609-799-3822
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02360300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist