Provider Demographics
NPI:1083737860
Name:STANT, JOHN DANA (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DANA
Last Name:STANT
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:PO BOX 2084
Mailing Address - Street 2:2162-1 RED ROCK CIRCLE
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-2084
Mailing Address - Country:US
Mailing Address - Phone:928-729-5928
Mailing Address - Fax:
Practice Address - Street 1:2162-1 RED ROCK CIRCLE
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-2084
Practice Address - Country:US
Practice Address - Phone:928-729-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028655L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist