Healthcare Provider Details

I. General information

NPI: 1891799888
Provider Name (Legal Business Name): MR. TODD S MICHAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 ALDERSGATE CIR
MECHANICSBURG PA
17050-8333
US

IV. Provider business mailing address

5275 ALDERSGATE CIR
MECHANICSBURG PA
17050-8333
US

V. Phone/Fax

Practice location:
  • Phone: 717-737-7476
  • Fax:
Mailing address:
  • Phone: 717-737-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP039097L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: