Provider Demographics
NPI:1568760767
Name:STANSELL, JAMES LAWRENCE (BS RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWRENCE
Last Name:STANSELL
Suffix:
Gender:M
Credentials:BS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601REYNOLDA RD
Mailing Address - Street 2:RIT AID
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2229
Mailing Address - Country:US
Mailing Address - Phone:336-924-9366
Mailing Address - Fax:
Practice Address - Street 1:3601REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2229
Practice Address - Country:US
Practice Address - Phone:336-924-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0346759Medicaid