Provider Demographics
NPI:1932275823
Name:SMITH, STANLEY N (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:N
Last Name:SMITH
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 1:245 LEON A WILDES RD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-7833
Mailing Address - Country:US
Mailing Address - Phone:912-375-4703
Mailing Address - Fax:912-367-1132
Practice Address - Street 1:438 W PARKER ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0649
Practice Address - Country:US
Practice Address - Phone:912-367-1155
Practice Address - Fax:912-367-1132
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist