Thomas Ray Stanford
Individual provider Active NPI Pharmacist · Eldorado, IL
NPI 1972605822 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972605822
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- Practice address
- 1201 Pine St
Eldorado, IL 62930-1634 - Phone
- (618) 273-3361
- Fax
- (618) 273-2504
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051287368 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | IL | Yes |
Addresses
Primary practice location
1201 Pine St
Eldorado, IL 62930-1634
Mailing address
1030 Davis Rd
Eldorado, IL 62930-3059
Phone (618) 268-6867
Other providers in Eldorado, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.