Provider Demographics
NPI:1972936540
Name:STAINBACK, DENA J (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:J
Last Name:STAINBACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-2441
Mailing Address - Country:US
Mailing Address - Phone:229-686-5113
Mailing Address - Fax:
Practice Address - Street 1:402 S DAVIS ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2441
Practice Address - Country:US
Practice Address - Phone:229-686-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist