Provider Demographics
NPI:1548562168
Name:STANLEY, ROBERT WAYNE (PHARM D)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAYNE
Last Name:STANLEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 CRESTWICK CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0601
Mailing Address - Country:US
Mailing Address - Phone:704-942-0492
Mailing Address - Fax:
Practice Address - Street 1:6200 CRESTWICK CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0601
Practice Address - Country:US
Practice Address - Phone:704-942-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18721183500000X
TX22766183500000X
NM3993183500000X
SC11723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist