Provider Demographics
NPI:1386967297
Name:PEISSIG, TODD A (RPH)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:A
Last Name:PEISSIG
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 1:190 MEDFORD PLZ
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1595
Mailing Address - Country:US
Mailing Address - Phone:715-748-2122
Mailing Address - Fax:715-748-9256
Practice Address - Street 1:190 MEDFORD PLZ
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1595
Practice Address - Country:US
Practice Address - Phone:715-748-2122
Practice Address - Fax:715-748-9256
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11415040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist