Provider Demographics
NPI:1740644863
Name:STROUD, STEPHEN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:STROUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855-4019
Mailing Address - Country:US
Mailing Address - Phone:479-963-6400
Mailing Address - Fax:479-963-2103
Practice Address - Street 1:508 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-4019
Practice Address - Country:US
Practice Address - Phone:479-963-6400
Practice Address - Fax:479-963-2103
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist