Provider Demographics
NPI:1215381496
Name:R STANFORD ENTERPRISES INC
Entity Type:Organization
Organization Name:R STANFORD ENTERPRISES INC
Other - Org Name:RENA'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-457-4555
Mailing Address - Street 1:615 PARKMAN CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4940
Mailing Address - Country:US
Mailing Address - Phone:267-457-4555
Mailing Address - Fax:215-307-3176
Practice Address - Street 1:2904 S 70TH ST
Practice Address - Street 2:UNIT 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2565
Practice Address - Country:US
Practice Address - Phone:267-457-4555
Practice Address - Fax:215-307-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4826383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy