MEDICARE: STROUD COMPOUNDING AND WELLNESS DRUGSTORE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PP481651	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2136912	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366500431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STROUD COMPOUNDING AND WELLNESS DRUGSTORE CORP

Provider Business Mailing Address
First Line	:	1619 N 9TH ST
Second Line	:	STE 3
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6501
Country	:	US
Telephone Number	:	570-476-6936
Fax Number	:	570-476-6938

Provider Business Practice Location Address
First Line	:	1619 N 9TH ST
Second Line	:	STE 3
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6501
Country	:	US
Telephone Number	:	570-476-6936
Fax Number	:	570-476-6938

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES CHIKWANHA
Credential	:
Telephone Number	:	570-476-6936

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/19/2025

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Directions to “STROUD COMPOUNDING AND WELLNESS DRUGSTORE CORP ” Practice Location

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