Provider Demographics
NPI:1659970325
Name:MWENDAR, STANLEY KUPATA (RPH)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:KUPATA
Last Name:MWENDAR
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 1:5525 E THOMAS RD UNIT D3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-8158
Mailing Address - Country:US
Mailing Address - Phone:480-290-6632
Mailing Address - Fax:
Practice Address - Street 1:1209 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2605
Practice Address - Country:US
Practice Address - Phone:602-282-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0160621835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric