Healthcare Provider Details

I. General information

NPI: 1720941271
Provider Name (Legal Business Name): TODD BRYAN HIRST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

IV. Provider business mailing address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-7557
  • Fax:
Mailing address:
  • Phone: 856-641-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04448500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: