Provider Demographics
NPI:1295458776
Name:STANTON, BERNADETTE (RPH)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11121 CATAYA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6705 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-1101
Practice Address - Country:US
Practice Address - Phone:702-547-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist