Provider Demographics
NPI:1285699959
Name:STAL PARTNERS LLC
Entity type:Organization
Organization Name:STAL PARTNERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHENIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-864-2217
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-0488
Mailing Address - Country:US
Mailing Address - Phone:478-864-2217
Mailing Address - Fax:478-864-1985
Practice Address - Street 1:8691 N MARCUS ST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-2025
Practice Address - Country:US
Practice Address - Phone:478-864-2217
Practice Address - Fax:478-864-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0101313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000036506AMedicaid
2152628OtherPK
7496250001Medicare NSC