Healthcare Provider Details

I. General information

NPI: 1245838291
Provider Name (Legal Business Name): TODD JAMES KUDRONOWICZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PROGRESSIVE PKWY
PLATTEVILLE WI
53818-3800
US

IV. Provider business mailing address

1800 PROGRESSIVE PKWY
PLATTEVILLE WI
53818-3800
US

V. Phone/Fax

Practice location:
  • Phone: 800-400-8569
  • Fax: 608-348-7809
Mailing address:
  • Phone: 800-400-8569
  • Fax: 608-348-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12389-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: