Provider Demographics
NPI:1427527282
Name:MAYNARD, TODD C (RP044762L)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:RP044762L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MALLARD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1222
Mailing Address - Country:US
Mailing Address - Phone:717-443-1249
Mailing Address - Fax:
Practice Address - Street 1:1195 LOWTHER RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7531
Practice Address - Country:US
Practice Address - Phone:717-737-9230
Practice Address - Fax:717-737-9643
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044762L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist