Healthcare Provider Details

I. General information

NPI: 1558450247
Provider Name (Legal Business Name): TODDS NORTHSIDE PROFESSIONAL PCHY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N ROAD ST STE A1
ELIZABETH CITY NC
27909-3354
US

IV. Provider business mailing address

PO BOX 1448
ELIZABETH CITY NC
27906-1448
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-1333
  • Fax: 252-331-1911
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05351
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOEL TWIFORD
Title or Position: PRES
Credential:
Phone: 252-331-1333