MEDICARE: TODD G STRAIN RPH

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	3336C0004X	Compounding Pharmacy	20614	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4500923753	OTHER	TX	CLIA
2	20614	OTHER	TX	PHARMACY LICENSE
3	L0118826	OTHER	TX	DPS
4	4517162	OTHER	TX	NCPDP

General Provider Information

NPI Number	:	1891984134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD G STRAIN RPH

Provider Business Mailing Address
First Line	:	411 LAKEVIEW ST
Second Line	:
City	:	GLEN ROSE
State	:	TX
Zip	:	76043-5029
Country	:	US
Telephone Number	:	254-898-1818
Fax Number	:	254-898-1819

Provider Business Practice Location Address
First Line	:	602C SOUTH MORGAN ST
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-1962
Country	:	US
Telephone Number	:	817-573-2512
Fax Number	:	817-573-3098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	03/07/2023

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Directions to “ TODD G STRAIN RPH” Practice Location

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