Provider Demographics
NPI:1598033193
Name:MUCHNIKOFF, STANLEY JASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JASON
Last Name:MUCHNIKOFF
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-8492
Mailing Address - Country:US
Mailing Address - Phone:575-647-2506
Mailing Address - Fax:575-647-1933
Practice Address - Street 1:2300 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8492
Practice Address - Country:US
Practice Address - Phone:575-647-2506
Practice Address - Fax:575-647-1933
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist