MEDICARE: MR. STANLEY BLACKSTONE RPH.

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	20389	TX

General Provider Information

NPI Number	:	1215938790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STANLEY BLACKSTONE RPH.

Provider Business Mailing Address
First Line	:	202 ECHO VALLEY DR
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-2111
Country	:	US
Telephone Number	:	830-775-0704
Fax Number	:	830-775-0704

Provider Business Practice Location Address
First Line	:	801 N BEDELL AVE
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-4112
Country	:	US
Telephone Number	:	830-775-9136
Fax Number	:	830-778-3694

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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