Provider Demographics
NPI:1780914994
Name:MCQUEEN, STEPHEN BRIAN (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRIAN
Last Name:MCQUEEN
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 1:2075 W PINNACLE PEAK RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1217
Mailing Address - Country:US
Mailing Address - Phone:623-215-0407
Mailing Address - Fax:623-215-0423
Practice Address - Street 1:2075 W PINNACLE PEAK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1217
Practice Address - Country:US
Practice Address - Phone:623-215-0407
Practice Address - Fax:623-215-0423
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11050183500000X
MI5302029259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist