Provider Demographics
NPI:1982825626
Name:STAINBACK, ANTHONY TODD (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:TODD
Last Name:STAINBACK
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 1:801 PONCE COURT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322
Mailing Address - Country:US
Mailing Address - Phone:757-482-2844
Mailing Address - Fax:757-388-1202
Practice Address - Street 1:600 GRESHAM DRIVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-388-1204
Practice Address - Fax:757-388-1202
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0202007614OtherPHARMACIST LICENSE