Provider Demographics
NPI:1952579922
Name:STROUD, THERESA R (RPH)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:R
Last Name:STROUD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CLINTON PL
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8006
Mailing Address - Country:US
Mailing Address - Phone:201-307-1557
Mailing Address - Fax:201-307-1584
Practice Address - Street 1:5 CLINTON PL
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8006
Practice Address - Country:US
Practice Address - Phone:201-307-1557
Practice Address - Fax:201-307-1584
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02518700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist