Provider Demographics
NPI:1629065545
Name:GREENBERG, STANLEY BURTON (RPH)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:BURTON
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13637 BAYLISS RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1814
Mailing Address - Country:US
Mailing Address - Phone:310-472-0830
Mailing Address - Fax:310-471-4566
Practice Address - Street 1:13637 BAYLISS RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1814
Practice Address - Country:US
Practice Address - Phone:310-472-0830
Practice Address - Fax:310-471-4566
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH18407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH18407OtherPHARMACIST LICENSE