Provider Demographics
NPI:1043441496
Name:STANLEY, RICHARD WADE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WADE
Last Name:STANLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400A S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-1555
Mailing Address - Country:US
Mailing Address - Phone:731-836-7211
Mailing Address - Fax:731-836-0344
Practice Address - Street 1:400A S CHURCH ST
Practice Address - Street 2:
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-1555
Practice Address - Country:US
Practice Address - Phone:731-836-7211
Practice Address - Fax:731-836-0344
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist