Provider Demographics
NPI:1467449090
Name:RENTZ, STANLEY MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:MICHAEL
Last Name:RENTZ
Suffix:
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 1:111 E GORDON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-4554
Mailing Address - Country:US
Mailing Address - Phone:229-244-8083
Mailing Address - Fax:229-245-6031
Practice Address - Street 1:111 E GORDON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4554
Practice Address - Country:US
Practice Address - Phone:229-242-1925
Practice Address - Fax:229-245-6031
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist