Provider Demographics
NPI:1346644390
Name:STANLEY, JERANICE EVANGELINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JERANICE
Middle Name:EVANGELINE
Last Name:STANLEY
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:PO BOX 1837
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-1837
Mailing Address - Country:US
Mailing Address - Phone:425-999-0000
Mailing Address - Fax:
Practice Address - Street 1:27016 NE DOROTHY ST
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8346
Practice Address - Country:US
Practice Address - Phone:425-999-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00013787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist