Provider Demographics
NPI:1073652715
Name:STROUP, ROGER L (RPH)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:L
Last Name:STROUP
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 1:90 N DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1325
Mailing Address - Country:US
Mailing Address - Phone:419-524-0521
Mailing Address - Fax:419-525-2668
Practice Address - Street 1:90 N DIAMOND ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1325
Practice Address - Country:US
Practice Address - Phone:419-524-0521
Practice Address - Fax:419-525-2668
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03110896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist