MEDICARE: MICHAEL AMOS STEPP PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	C5662	TN

General Provider Information

NPI Number	:	1689706939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL AMOS STEPP PHARMACIST

Provider Business Mailing Address
First Line	:	101 HIGHLAND RIDGE CT
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4498
Country	:	US
Telephone Number	:	423-753-6664
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 FOREST DR
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1510
Country	:	US
Telephone Number	:	423-753-3468
Fax Number	:	423-753-4274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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