Provider Demographics
NPI:1194787721
Name:STOCKSTILL, DENNIS LYNN (RPH)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:LYNN
Last Name:STOCKSTILL
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:PO BOX 310
Mailing Address - Street 2:104 W. MCCLURG AVE
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0310
Mailing Address - Country:US
Mailing Address - Phone:573-765-3321
Mailing Address - Fax:573-765-5200
Practice Address - Street 1:104 MCCLURG ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556-9998
Practice Address - Country:US
Practice Address - Phone:573-765-3321
Practice Address - Fax:573-765-5200
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist