Provider Demographics
NPI:1073502902
Name:MAGOTEAUX, STEVEN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:MAGOTEAUX
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 1:4950 TILLAMOOK TRL
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-4121
Mailing Address - Country:US
Mailing Address - Phone:419-224-4884
Mailing Address - Fax:
Practice Address - Street 1:701 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4601
Practice Address - Country:US
Practice Address - Phone:419-223-8906
Practice Address - Fax:419-222-1619
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-17379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist