Provider Demographics
NPI:1124359542
Name:STEEN, MARIA JEANNINE FUGATE (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JEANNINE FUGATE
Last Name:STEEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LEANING OAK DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6991
Mailing Address - Country:US
Mailing Address - Phone:704-658-1184
Mailing Address - Fax:704-658-1184
Practice Address - Street 1:108 LEANING OAK DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6991
Practice Address - Country:US
Practice Address - Phone:704-658-1184
Practice Address - Fax:704-658-1184
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist