Provider Demographics
NPI:1356600696
Name:STROUD, LEONORA THERESE (RPH)
Entity type:Individual
Prefix:
First Name:LEONORA
Middle Name:THERESE
Last Name:STROUD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:WALTRIP
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:232 G ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2019
Mailing Address - Country:US
Mailing Address - Phone:719-539-6933
Mailing Address - Fax:
Practice Address - Street 1:232 G ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2019
Practice Address - Country:US
Practice Address - Phone:719-539-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist