Provider Demographics
NPI:1205147436
Name:STANCIL, DAVID RICHEY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHEY
Last Name:STANCIL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4529
Mailing Address - Country:US
Mailing Address - Phone:706-260-2628
Mailing Address - Fax:706-260-2634
Practice Address - Street 1:2225 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4529
Practice Address - Country:US
Practice Address - Phone:706-260-2628
Practice Address - Fax:706-260-2634
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013039183500000X
TN11583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH013039OtherGEORGIA BOARD OF PHARMACY
TN11583OtherTN BOARD OF PHARMACY