Provider Demographics
NPI:1346836723
Name:STANLEY, DENISE MICHELLE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:STANLEY
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 1:3717 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55126-3081
Mailing Address - Country:US
Mailing Address - Phone:651-483-1504
Mailing Address - Fax:
Practice Address - Street 1:3717 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55126-3081
Practice Address - Country:US
Practice Address - Phone:651-483-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist