Provider Demographics
NPI:1467969840
Name:STAHL, ARCHIE (DPH)
Entity Type:Individual
Prefix:
First Name:ARCHIE
Middle Name:
Last Name:STAHL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 MALLORY LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8304
Mailing Address - Country:US
Mailing Address - Phone:615-778-9993
Mailing Address - Fax:615-778-9996
Practice Address - Street 1:3070 MALLORY LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8304
Practice Address - Country:US
Practice Address - Phone:615-778-9993
Practice Address - Fax:615-778-9996
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist