Healthcare Provider Details

I. General information

NPI: 1316938335
Provider Name (Legal Business Name): BOBBY DEAN STONE JR. R.PH., CDM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S LEROY ST
METTER GA
30439-4631
US

IV. Provider business mailing address

150 S LEROY ST
METTER GA
30439-4631
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-2803
  • Fax: 912-685-3777
Mailing address:
  • Phone: 912-685-2803
  • Fax: 912-685-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: