Healthcare Provider Details

I. General information

NPI: 1720262975
Provider Name (Legal Business Name): BONNIE STEGER R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAIN STREET
MORAVIA NY
13118
US

IV. Provider business mailing address

130 MAIN STREET
MORAVIA NY
13118
US

V. Phone/Fax

Practice location:
  • Phone: 315-497-9600
  • Fax:
Mailing address:
  • Phone: 315-497-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number031065
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: