Provider Demographics
NPI:1598272734
Name:MOELLER, STEVEN A
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:MOELLER
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 1:16990 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-9508
Mailing Address - Country:US
Mailing Address - Phone:209-394-2845
Mailing Address - Fax:
Practice Address - Street 1:1030 SPERRY AVE
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9267
Practice Address - Country:US
Practice Address - Phone:209-895-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist