Provider Demographics
NPI:1104264704
Name:MADDEN, STEVEN (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MADDEN
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 1:1601 SANDIFER BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0905
Mailing Address - Country:US
Mailing Address - Phone:864-885-0889
Mailing Address - Fax:
Practice Address - Street 1:1601 SANDIFER BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0905
Practice Address - Country:US
Practice Address - Phone:864-885-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist