Provider Demographics
NPI:1437752268
Name:STEGEN, WAYNE RAY
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:RAY
Last Name:STEGEN
Suffix:
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 1:1445 E CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-4323
Mailing Address - Country:US
Mailing Address - Phone:636-583-7958
Mailing Address - Fax:
Practice Address - Street 1:1445 E CENTRAL CT
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4323
Practice Address - Country:US
Practice Address - Phone:636-583-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist