MEDICARE: KEVIN F STANLEY 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	0202005010	VA

General Provider Information

NPI Number	:	1770806937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN F STANLEY RPH

Provider Business Mailing Address
First Line	:	5432 GLENSIDE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-3915
Country	:	US
Telephone Number	:	804-672-3570
Fax Number	:	804-672-3380

Provider Business Practice Location Address
First Line	:	5432 GLENSIDE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-3915
Country	:	US
Telephone Number	:	804-672-3570
Fax Number	:	804-672-3380

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

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/02/2010

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