Healthcare Provider Details

I. General information

NPI: 1114822459
Provider Name (Legal Business Name): LISA DAWN TODD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MAIN ST
CONWAY SC
29526-3568
US

IV. Provider business mailing address

5659 HIGHWAY 905
CONWAY SC
29526-7157
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-4609
  • Fax: 843-488-0770
Mailing address:
  • Phone: 843-248-4609
  • Fax: 843-488-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7975
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: