Provider Demographics
NPI:1326472242
Name:KRUPP, CHAD ANTHONY (PHARMD, MBA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ANTHONY
Last Name:KRUPP
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 SHEPHERDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-5046
Mailing Address - Country:US
Mailing Address - Phone:502-445-6593
Mailing Address - Fax:
Practice Address - Street 1:9104 SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5046
Practice Address - Country:US
Practice Address - Phone:502-445-6593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist