Provider Demographics
NPI:1306128459
Name:STEUCK, DEBRA A (RPH)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:STEUCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1526
Mailing Address - Country:US
Mailing Address - Phone:608-643-5182
Mailing Address - Fax:608-643-5209
Practice Address - Street 1:333 PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1526
Practice Address - Country:US
Practice Address - Phone:608-643-5182
Practice Address - Fax:608-643-5209
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12356OtherREGISTERED PHARMACIST