Provider Demographics
NPI:1033461488
Name:TODD, TONYA LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNN
Last Name:TODD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:TONYA
Other - Middle Name:LYNN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3568
Mailing Address - Country:US
Mailing Address - Phone:843-248-4609
Mailing Address - Fax:843-488-0770
Practice Address - Street 1:1401 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3568
Practice Address - Country:US
Practice Address - Phone:843-248-4609
Practice Address - Fax:843-488-0770
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist