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General NPI Number Information
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NPI Number | 1154615524
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Entity Type | Individual
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Provider Name | STEVEN DETTER RPH
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Gender | Male
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 2344 S CHURCH ST
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City | BURLINGTON
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State | NC
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Zip | 27215-5332
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Country | US
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Telephone | 336-227-7442
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Fax | 336-222-1998
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Provider Business Mailing Address
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Address Line | 4318 DOGWOOD RD
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City | BURLINGTON
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State | NC
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Zip | 27215-8628
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Country | US
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Telephone | 336-263-1602
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Fax | 336-222-1998
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6231
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License Number State | NC
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