Provider Demographics
NPI:1467005835
Name:CARTER, STEVE BRYANT
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:BRYANT
Last Name:CARTER
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 1:9080 QUAIL TERRACE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4003
Mailing Address - Country:US
Mailing Address - Phone:916-690-6446
Mailing Address - Fax:
Practice Address - Street 1:9080 QUAIL TERRACE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4003
Practice Address - Country:US
Practice Address - Phone:916-690-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist