Provider Demographics
NPI:1083832471
Name:STODDARD, BRIAN A (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:STODDARD
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 1:13100 UPTON RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808-8434
Mailing Address - Country:US
Mailing Address - Phone:517-641-4018
Mailing Address - Fax:
Practice Address - Street 1:1589 HASLETT RD
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8424
Practice Address - Country:US
Practice Address - Phone:517-339-5832
Practice Address - Fax:517-339-0135
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist