Provider Demographics
NPI:1700475126
Name:STROUD, MARK RICHARD (BS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:STROUD
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 HARRIS POND RD
Mailing Address - Street 2:
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-2402
Mailing Address - Country:US
Mailing Address - Phone:570-823-3151
Mailing Address - Fax:
Practice Address - Street 1:79 E CAREY ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-2007
Practice Address - Country:US
Practice Address - Phone:570-823-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041406L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist