MEDICARE: RICHARD WADE STANLEY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8249	TN

General Provider Information

NPI Number	:	1043441496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD WADE STANLEY PHARMD

Provider Business Mailing Address
First Line	:	400A S CHURCH ST
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-1555
Country	:	US
Telephone Number	:	731-836-7211
Fax Number	:	731-836-0344

Provider Business Practice Location Address
First Line	:	400A S CHURCH ST
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-1555
Country	:	US
Telephone Number	:	731-836-7211
Fax Number	:	731-836-0344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	06/17/2023

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