Provider Demographics
NPI:1316350820
Name:PADELLFORD, TROY (RPH)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:PADELLFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-3121
Mailing Address - Country:US
Mailing Address - Phone:641-842-1433
Mailing Address - Fax:
Practice Address - Street 1:1002 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3121
Practice Address - Country:US
Practice Address - Phone:641-842-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist