Active NPI
Carl Lake Stanley Jr., RPH, CDM
- Pharmacist
- Gordon, GA
National Provider Identifier
1730101353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10890
- Practice address
- 240 Milledgeville Hwy
Gordon, GA 31031-3827 - Phone
- (478) 628-2425
- Fax
- (478) 628-2263
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10890 | GA | Primary |
Addresses
Primary practice location
240 Milledgeville Hwy
Gordon, GA 31031-3827
Mailing address
PO Box 249
Gordon, GA 31031-0249
Phone (478) 628-2425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10890 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gordon Drugs, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264636800000",
"number": "1730101353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 249",
"city": "GORDON",
"state": "GA",
"postal_code": "310310249",
"telephone_number": "478-628-2425",
"fax_number": "478-628-2263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 MILLEDGEVILLE HWY",
"city": "GORDON",
"state": "GA",
"postal_code": "310313827",
"telephone_number": "478-628-2425",
"fax_number": "478-628-2263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "CARL",
"middle_name": "LAKE",
"name_suffix": "Jr.",
"credential": "RPH, CDM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2010-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "10890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.