Provider Demographics
NPI:1992847735
Name:STONES PHARMACY INC.
Entity Type:Organization
Organization Name:STONES PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ORDWAY
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:262-782-0460
Mailing Address - Street 1:14105 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1640
Mailing Address - Country:US
Mailing Address - Phone:262-782-0460
Mailing Address - Fax:262-782-4124
Practice Address - Street 1:14105 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1640
Practice Address - Country:US
Practice Address - Phone:262-782-0460
Practice Address - Fax:262-782-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5269-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33108500Medicaid