Provider Demographics
NPI:1316166671
Name:STAFFORD, SYLVIA ROSE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:ROSE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 GODWIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6331
Mailing Address - Country:US
Mailing Address - Phone:919-894-7492
Mailing Address - Fax:
Practice Address - Street 1:609 E CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5021
Practice Address - Country:US
Practice Address - Phone:910-892-2114
Practice Address - Fax:910-892-9110
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC10137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0435081Medicaid
NC1356448294OtherSTORE NPI #
NC0435081Medicaid