Provider Demographics
NPI:1629390703
Name:STANKO, JUSTINA M (RPH)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:M
Last Name:STANKO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JAMES
Other - Middle Name:E
Other - Last Name:STANKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:71 MITCHELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-722-0387
Mailing Address - Fax:607-748-7859
Practice Address - Street 1:71 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1618
Practice Address - Country:US
Practice Address - Phone:607-722-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01440431Medicaid