Provider Demographics
NPI:1124036603
Name:STEELE, JOHN LEROY JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEROY
Last Name:STEELE
Suffix:JR
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 1:583 OLD IRON WORKS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4452
Mailing Address - Country:US
Mailing Address - Phone:864-598-9457
Mailing Address - Fax:
Practice Address - Street 1:4795 S CHURCH STREET EXT
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3202
Practice Address - Country:US
Practice Address - Phone:864-595-1220
Practice Address - Fax:864-595-1433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4225769OtherNCPDP