Provider Demographics
NPI:1558442640
Name:STANLEY PHARMACY, INC
Entity Type:Organization
Organization Name:STANLEY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-778-2219
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:VA
Mailing Address - Zip Code:22851-0160
Mailing Address - Country:US
Mailing Address - Phone:540-778-2219
Mailing Address - Fax:540-778-1714
Practice Address - Street 1:308 E. MAIN
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:VA
Practice Address - Zip Code:22851-0160
Practice Address - Country:US
Practice Address - Phone:540-778-2219
Practice Address - Fax:540-778-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010013253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4810784OtherNCPDP
VA8510296Medicaid
VA8510296Medicaid