Provider Demographics
NPI:1205109295
Name:STEFFEN, TRENT RICHARD (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:RICHARD
Last Name:STEFFEN
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 HUNTERS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-7777
Mailing Address - Country:US
Mailing Address - Phone:336-870-1479
Mailing Address - Fax:
Practice Address - Street 1:11220 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2891
Practice Address - Country:US
Practice Address - Phone:336-434-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14173183500000X
IA16668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist