Healthcare Provider Details

I. General information

NPI: 1164553533
Provider Name (Legal Business Name): TODD GUNDRUM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ARLINGTON AVE MAIL STOP 1060
TOLEDO OH
43614-2595
US

IV. Provider business mailing address

3424 GALLATIN RD
OTTAWA HILLS OH
43606-2442
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-3875
  • Fax: 419-383-3032
Mailing address:
  • Phone: 419-539-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-21273
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: