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General NPI Number Information
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NPI Number | 1215531546
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL STANLEY RPH
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Gender | Male
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Dates
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Enumeration Date | 11/27/2020
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Last Update Date | 11/27/2020
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Provider Practice Location Address
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Address Line | 3310 E JACKSON ST
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City | MUNCIE
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State | IN
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Zip | 47303-5170
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Country | US
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Telephone | 765-286-0934
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Fax | 765-741-8745
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Provider Business Mailing Address
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Address Line | 3310 E JACKSON ST
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City | MUNCIE
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State | IN
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Zip | 47303-5170
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Country | US
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Telephone | 765-286-0933
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Fax | 765-741-8745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26017015A
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License Number State | IN
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