Provider Demographics
NPI:1972992402
Name:BARANEC, STEPHEN A (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
Last Name:BARANEC
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 1:1753 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-6014
Mailing Address - Country:US
Mailing Address - Phone:231-943-1714
Mailing Address - Fax:
Practice Address - Street 1:3250 US HIGHWAY 41 W
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9483
Practice Address - Country:US
Practice Address - Phone:906-226-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9999999Medicaid
MI99999999Medicaid