Healthcare Provider Details

I. General information

NPI: 1780967125
Provider Name (Legal Business Name): MARK WILLIAM TOETZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 N MAIN ST
BLUFFTON IN
46714
US

IV. Provider business mailing address

305 S WAYNE STREET
BLUFFTON IN
46714
US

V. Phone/Fax

Practice location:
  • Phone: 260-824-1643
  • Fax: 260-824-3980
Mailing address:
  • Phone: 260-824-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016729A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: