Provider Demographics
NPI:1376815951
Name:STROUD COMPOUNDING AND WELLNESS DRUGSTORE, CORP
Entity Type:Organization
Organization Name:STROUD COMPOUNDING AND WELLNESS DRUGSTORE, CORP
Other - Org Name:STROUD COMPOUNDING AND WELLNESS PHARMACY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKWANHA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:570-476-6936
Mailing Address - Street 1:7400 ROUTE 611
Mailing Address - Street 2:SUITE 3
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-8384
Mailing Address - Country:US
Mailing Address - Phone:570-476-6936
Mailing Address - Fax:570-476-6938
Practice Address - Street 1:7400 ROUTE 611
Practice Address - Street 2:SUITE 3
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-8384
Practice Address - Country:US
Practice Address - Phone:570-476-6936
Practice Address - Fax:570-476-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service