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General NPI Number Information
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NPI Number | 1780459347
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Entity Type | Individual
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Provider Name | TODD VERDEYEN RPH
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Gender | Male
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Dates
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Enumeration Date | 11/23/2023
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Last Update Date | 11/23/2023
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Provider Practice Location Address
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Address Line | 805 W FAYETTE AVE
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City | EFFINGHAM
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State | IL
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Zip | 62401-2415
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Country | US
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Telephone | 217-690-6235
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Fax |
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Provider Business Mailing Address
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Address Line | 707 W GRANT AVE
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City | ALTAMONT
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State | IL
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Zip | 62411-1044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26022369A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2007022174
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051-040083
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License Number State | IL
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