Provider Demographics
NPI:1891984134
Name:STRAIN, TODD G (RPH)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:G
Last Name:STRAIN
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 1:411 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-5029
Mailing Address - Country:US
Mailing Address - Phone:254-898-1818
Mailing Address - Fax:254-898-1819
Practice Address - Street 1:602C SOUTH MORGAN ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1962
Practice Address - Country:US
Practice Address - Phone:817-573-2512
Practice Address - Fax:817-573-3098
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206143336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4500923753OtherCLIA
TX20614OtherPHARMACY LICENSE
TXL0118826OtherDPS
TX4517162OtherNCPDP
TX4517162OtherNCPDP