Provider Demographics
NPI:1053696518
Name:STANLEY, WILLIAM STEPHEN (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STEPHEN
Last Name:STANLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1841
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740
Mailing Address - Country:US
Mailing Address - Phone:520-921-9495
Mailing Address - Fax:575-445-5393
Practice Address - Street 1:955 SOUTH SECOND STREET
Practice Address - Street 2:DEL NORTE PHARMACY
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740
Practice Address - Country:US
Practice Address - Phone:575-445-5163
Practice Address - Fax:575-445-5393
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000048181835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support