Healthcare Provider Details

I. General information

NPI: 1740262922
Provider Name (Legal Business Name): RICHARD D STANIEC RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 RED STONE RDG
DELRAN NJ
08075-2031
US

IV. Provider business mailing address

113 RED STONE RDG
DELRAN NJ
08075-2031
US

V. Phone/Fax

Practice location:
  • Phone: 856-764-7161
  • Fax:
Mailing address:
  • Phone: 856-764-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030267L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI02896500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: