Provider Demographics
NPI:1669788535
Name:STEGALL, MICHAEL J (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:STEGALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROBINOOD MEDICAL PLAZA
Mailing Address - Street 2:NOVANT PHARMACY AT MAPLEWOOD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4702
Mailing Address - Country:US
Mailing Address - Phone:336-718-0560
Mailing Address - Fax:336-718-0567
Practice Address - Street 1:100 ROBINOOD MEDICAL PLAZA
Practice Address - Street 2:NOVANT PHARMACY AT MAPLEWOOD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4702
Practice Address - Country:US
Practice Address - Phone:336-718-0560
Practice Address - Fax:336-718-0567
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6217183500000X
VA0202205422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist