Provider Demographics
NPI:1326593229
Name:STASNY, ADA (RPH)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:STASNY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 BUERKLE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5245
Mailing Address - Country:US
Mailing Address - Phone:651-779-6710
Mailing Address - Fax:657-799-7327
Practice Address - Street 1:1850 BUERKLE RD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-5245
Practice Address - Country:US
Practice Address - Phone:651-779-6710
Practice Address - Fax:657-799-7327
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist