Provider Demographics
NPI:1003103961
Name:MEESKE, TODD
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:MEESKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 ELMORE AVE
Mailing Address - Street 2:T-0533
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5225 ELMORE AVE
Practice Address - Street 2:T-0533
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3454
Practice Address - Country:US
Practice Address - Phone:563-344-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist