Provider Demographics
NPI:1760752273
Name:STEYN, PIETER JOHANNES
Entity Type:Individual
Prefix:
First Name:PIETER
Middle Name:JOHANNES
Last Name:STEYN
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 1:78935 HIGHWAY 111
Mailing Address - Street 2:T-1867
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2072
Mailing Address - Country:US
Mailing Address - Phone:760-777-8469
Mailing Address - Fax:
Practice Address - Street 1:78935 HIGHWAY 111
Practice Address - Street 2:T-1867
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2072
Practice Address - Country:US
Practice Address - Phone:760-777-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist