MEDICARE: STANLEY MICHAEL RENTZ 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	12624	GA

General Provider Information

NPI Number	:	1467449090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY MICHAEL RENTZ RPH

Provider Business Mailing Address
First Line	:	111 E GORDON ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-4554
Country	:	US
Telephone Number	:	229-244-8083
Fax Number	:	229-245-6031

Provider Business Practice Location Address
First Line	:	111 E GORDON ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-4554
Country	:	US
Telephone Number	:	229-242-1925
Fax Number	:	229-245-6031

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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