Provider Demographics
NPI:1659619740
Name:STANKO, JOHN M (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:STANKO
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 1:45 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2262
Mailing Address - Country:US
Mailing Address - Phone:843-689-2276
Mailing Address - Fax:843-689-6252
Practice Address - Street 1:45 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2262
Practice Address - Country:US
Practice Address - Phone:843-689-2276
Practice Address - Fax:843-689-6252
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist