Provider Demographics
NPI:1215249347
Name:STANSBURY, SALLY (PHARM D)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 1210
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2520
Mailing Address - Country:US
Mailing Address - Phone:225-284-7820
Mailing Address - Fax:
Practice Address - Street 1:500 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5417
Practice Address - Country:US
Practice Address - Phone:617-732-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist