Provider Demographics
NPI:1124172481
Name:TETENMAN, STANLEY L (RPH)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:L
Last Name:TETENMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ROCKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-7529
Mailing Address - Country:US
Mailing Address - Phone:207-998-2767
Mailing Address - Fax:
Practice Address - Street 1:55 ROCKWOOD LN
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-7529
Practice Address - Country:US
Practice Address - Phone:207-998-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR2779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist