Provider Demographics
NPI:1972202315
Name:STANLEY SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:STANLEY SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-370-6612
Mailing Address - Street 1:3120 LATROBE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2185
Mailing Address - Country:US
Mailing Address - Phone:704-370-6612
Mailing Address - Fax:704-375-5888
Practice Address - Street 1:3120 LATROBE DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2185
Practice Address - Country:US
Practice Address - Phone:704-370-6612
Practice Address - Fax:704-375-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24598OtherNC STATE PHARMACY LICENSE