MEDICARE: MR. GARY STAPOLSY

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	RP038012L	PA

General Provider Information

NPI Number	:	1730283755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY STAPOLSY

Provider Business Mailing Address
First Line	:	US ARMY MEDICAL DEPARTMENT ACTIVITY, JAPAN
Second Line	:	UNIT 45011, BLDG 704, ATTN: MCJA-QM
City	:	APO
State	:	AP
Zip	:	96338-5011
Country	:	JP
Telephone Number	:	01181464078206
Fax Number	:	01181464078183

Provider Business Practice Location Address
First Line	:	301 BYBERRY RD
Second Line	:	APPT. B12
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1947
Country	:	US
Telephone Number	:	215-671-0510
Fax Number	:

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	07/21/2022

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