Provider Demographics
NPI:1902176209
Name:STODOLA, JOSEPH VINCENT III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:STODOLA
Suffix:III
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 1:6510 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-2748
Mailing Address - Country:US
Mailing Address - Phone:219-931-3332
Mailing Address - Fax:219-852-9201
Practice Address - Street 1:6510 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2748
Practice Address - Country:US
Practice Address - Phone:219-931-3332
Practice Address - Fax:219-852-9201
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26011215A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist