Provider Demographics
NPI:1992004196
Name:STALEY, DENNIS FRANKLIN (RPH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:FRANKLIN
Last Name:STALEY
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 1:3719 OLD ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8675
Mailing Address - Country:US
Mailing Address - Phone:770-475-8100
Mailing Address - Fax:770-772-6130
Practice Address - Street 1:3719 OLD ALABAMA RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8675
Practice Address - Country:US
Practice Address - Phone:770-475-8100
Practice Address - Fax:770-772-6130
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist