Provider Demographics
NPI:1487375580
Name:STROUD, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:STROUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 HIGHWAY 60 STE 400
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-2040
Mailing Address - Country:US
Mailing Address - Phone:812-461-0025
Mailing Address - Fax:
Practice Address - Street 1:7600 HIGHWAY 60 STE 400
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-2040
Practice Address - Country:US
Practice Address - Phone:812-461-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician