Provider Demographics
NPI:1285766857
Name:TODT, ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:TODT
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 1:644 HENSON RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0920
Mailing Address - Country:US
Mailing Address - Phone:423-878-5026
Mailing Address - Fax:
Practice Address - Street 1:220 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-6721
Practice Address - Country:US
Practice Address - Phone:423-968-9559
Practice Address - Fax:423-968-7524
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006211183500000X
VA0202006928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist