1972030310 NPI number — JACQUELINE JOAN TOMANEK-STANLEY PHARMD

Table of content: JACQUELINE JOAN TOMANEK-STANLEY PHARMD (NPI 1972030310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972030310 NPI number — JACQUELINE JOAN TOMANEK-STANLEY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMANEK-STANLEY
Provider First Name:
JACQUELINE
Provider Middle Name:
JOAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STANLEY
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972030310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73D WINTHROP AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-382-3423
Provider Business Mailing Address Fax Number:
978-722-3034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73D WINTHROP AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-382-3423
Provider Business Practice Location Address Fax Number:
978-722-3034
Provider Enumeration Date:
05/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  PH233489 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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