Provider Demographics
NPI:1598365777
Name:VANSTEENBERG, STEPHEN RAY
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RAY
Last Name:VANSTEENBERG
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 1:6839 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-7813
Mailing Address - Country:US
Mailing Address - Phone:304-617-4212
Mailing Address - Fax:
Practice Address - Street 1:354 PRIVATE DRIVE 288
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7900
Practice Address - Country:US
Practice Address - Phone:740-894-3517
Practice Address - Fax:740-894-4736
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010673183500000X
WVRP0005443183500000X
OH03129901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist