Provider Demographics
NPI:1043643158
Name:VAN STEEDEN, MICHAEL T
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:VAN STEEDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 VILLA AVE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4835
Mailing Address - Country:US
Mailing Address - Phone:203-336-3551
Mailing Address - Fax:
Practice Address - Street 1:740 VILLA AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4835
Practice Address - Country:US
Practice Address - Phone:203-336-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist