Provider Demographics
NPI:1154615524
Name:DETTER, STEVEN (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DETTER
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 1:4318 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8628
Mailing Address - Country:US
Mailing Address - Phone:336-263-1602
Mailing Address - Fax:336-222-1998
Practice Address - Street 1:2344 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5332
Practice Address - Country:US
Practice Address - Phone:336-227-7442
Practice Address - Fax:336-222-1998
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist