Provider Demographics
NPI:1215223987
Name:STEFFEN, BRET (RPH,)
Entity Type:Individual
Prefix:MR
First Name:BRET
Middle Name:
Last Name:STEFFEN
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 1:6140 FAIRMONT CT
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-7701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14546 DELLWOOD DR
Practice Address - Street 2:TARGET PHARMACY #0659
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-9744
Practice Address - Country:US
Practice Address - Phone:218-828-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist