Provider Demographics
NPI:1073800793
Name:TODD, KARIN LORENE (RPH)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:LORENE
Last Name:TODD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11568 156TH ST
Mailing Address - Street 2:
Mailing Address - City:MC ALPIN
Mailing Address - State:FL
Mailing Address - Zip Code:32062-2241
Mailing Address - Country:US
Mailing Address - Phone:386-362-5795
Mailing Address - Fax:386-362-5120
Practice Address - Street 1:911 PINEWOOD STREET
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060
Practice Address - Country:US
Practice Address - Phone:386-362-6350
Practice Address - Fax:386-362-6321
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS029790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist