Provider Demographics
NPI:1093094609
Name:STEELE, CHARLENE LEWIS
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:LEWIS
Last Name:STEELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6102
Mailing Address - Country:US
Mailing Address - Phone:207-622-8001
Mailing Address - Fax:207-622-8011
Practice Address - Street 1:119 CROSSING WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6102
Practice Address - Country:US
Practice Address - Phone:207-622-8001
Practice Address - Fax:207-622-8011
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR6087183500000X
KS1-15013183500000X
MA23973183500000X
NH2908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist