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General NPI Number Information
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NPI Number | 1215381496
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Entity Type | Organization
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Legal Business Name | R STANFORD ENTERPRISES INC
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 2904 S 70TH ST UNIT 3
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2565
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Country | US
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Telephone | 267-457-4555
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Fax | 215-307-3176
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Provider Business Mailing Address
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Address Line | 615 PARKMAN CT
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City | BEAR
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State | DE
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Zip | 19701-4940
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Country | US
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Telephone | 267-457-4555
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Fax | 215-307-3176
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MRS. RENA M STANFORD
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Credential | RPH
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Telephone | 267-457-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482638
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License Number State | PA
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