Provider Demographics
NPI:1932761046
Name:STIDHAM, PEYTON JOHNSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:JOHNSON
Last Name:STIDHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:PEYTON
Other - Middle Name:JOHNSON
Other - Last Name:STIDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6622 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1822
Mailing Address - Country:US
Mailing Address - Phone:502-964-0342
Mailing Address - Fax:
Practice Address - Street 1:6622 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1822
Practice Address - Country:US
Practice Address - Phone:502-964-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist