Provider Demographics
NPI:1558693820
Name:STANLEY, GREG ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:ROBERT
Last Name:STANLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 TECHNOLOGY PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9713
Mailing Address - Country:US
Mailing Address - Phone:315-434-1980
Mailing Address - Fax:315-434-1985
Practice Address - Street 1:15 TECHNOLOGY PL
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9713
Practice Address - Country:US
Practice Address - Phone:315-434-1980
Practice Address - Fax:315-434-1985
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY046096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist