Provider Demographics
NPI:1275146334
Name:MARION, STANLEY BRENT JR (RPH)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:BRENT
Last Name:MARION
Suffix:JR
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 1:880 S NEOSHO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-2052
Mailing Address - Country:US
Mailing Address - Phone:417-451-1535
Mailing Address - Fax:417-451-3983
Practice Address - Street 1:880 S NEOSHO BLVD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-2052
Practice Address - Country:US
Practice Address - Phone:417-451-1535
Practice Address - Fax:417-451-3983
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist