Provider Demographics
NPI:1003116500
Name:SADLER, STAN WILSON
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:WILSON
Last Name:SADLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 SKY POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4058
Mailing Address - Country:US
Mailing Address - Phone:702-515-1821
Mailing Address - Fax:702-515-1839
Practice Address - Street 1:6450 SKY POINTE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4058
Practice Address - Country:US
Practice Address - Phone:702-515-1821
Practice Address - Fax:702-515-1839
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH01783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist