Provider Demographics
NPI:1104256213
Name:THRASH, STANLEY (PD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:THRASH
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 E ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-0218
Mailing Address - Country:US
Mailing Address - Phone:479-750-2903
Mailing Address - Fax:
Practice Address - Street 1:3553 E ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-0218
Practice Address - Country:US
Practice Address - Phone:479-750-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist