Provider Demographics
NPI:1679885214
Name:STANCIL, JOHN WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WAYNE
Last Name:STANCIL
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 1:2653 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1667
Mailing Address - Country:US
Mailing Address - Phone:252-399-0760
Mailing Address - Fax:
Practice Address - Street 1:2653 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1667
Practice Address - Country:US
Practice Address - Phone:252-399-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist