Provider Demographics
NPI:1689706939
Name:STEPP, MICHAEL AMOS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AMOS
Last Name:STEPP
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HIGHLAND RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4498
Mailing Address - Country:US
Mailing Address - Phone:423-753-6664
Mailing Address - Fax:
Practice Address - Street 1:500 FOREST DR
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1510
Practice Address - Country:US
Practice Address - Phone:423-753-3468
Practice Address - Fax:423-753-4274
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC5662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist