Provider Demographics
NPI:1033433412
Name:EKLUM, TODD ERIC (RPH)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ERIC
Last Name:EKLUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:14138-0290
Mailing Address - Country:US
Mailing Address - Phone:716-988-3410
Mailing Address - Fax:716-988-3720
Practice Address - Street 1:303 PINE STREET
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTON
Practice Address - State:NY
Practice Address - Zip Code:14138-0290
Practice Address - Country:US
Practice Address - Phone:716-988-3410
Practice Address - Fax:716-988-3720
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist