Provider Demographics
NPI:1124157979
Name:STEELE, DAVID ROGER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROGER
Last Name:STEELE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 EASY ST # A
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-9009
Mailing Address - Country:US
Mailing Address - Phone:706-886-7309
Mailing Address - Fax:706-886-3110
Practice Address - Street 1:906 BIG A RD S
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-3812
Practice Address - Country:US
Practice Address - Phone:706-886-3119
Practice Address - Fax:706-886-3110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA022104OtherSTATE LICENSE NUMBER