Provider Demographics
NPI:1114527728
Name:STENCEL, SUZANNE LEE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LEE
Last Name:STENCEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-1603
Mailing Address - Country:US
Mailing Address - Phone:229-377-1451
Mailing Address - Fax:229-377-1385
Practice Address - Street 1:361 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-1603
Practice Address - Country:US
Practice Address - Phone:229-377-1451
Practice Address - Fax:229-377-1385
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist