MEDICARE: MR. BOBBY DEAN STONE JR. R.PH., CDM

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	017670	GA

General Provider Information

NPI Number	:	1316938335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BOBBY DEAN STONE JR. R.PH., CDM

Provider Business Mailing Address
First Line	:	150 S LEROY ST
Second Line	:
City	:	METTER
State	:	GA
Zip	:	30439-4631
Country	:	US
Telephone Number	:	912-685-2803
Fax Number	:	912-685-3777

Provider Business Practice Location Address
First Line	:	150 S LEROY ST
Second Line	:
City	:	METTER
State	:	GA
Zip	:	30439-4631
Country	:	US
Telephone Number	:	912-685-2803
Fax Number	:	912-685-3777

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	12/09/2021

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