Provider Demographics
NPI:1700294691
Name:STALNAKER, REBECCA (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STALNAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WALKERS VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8147
Mailing Address - Country:US
Mailing Address - Phone:301-845-2811
Mailing Address - Fax:
Practice Address - Street 1:110 WALKERS VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8147
Practice Address - Country:US
Practice Address - Phone:301-845-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist