Provider Demographics
NPI:1093014417
Name:DAVIDSON, TODD LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LYNN
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7269
Mailing Address - Country:US
Mailing Address - Phone:770-422-0518
Mailing Address - Fax:770-428-4391
Practice Address - Street 1:780 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7269
Practice Address - Country:US
Practice Address - Phone:770-422-0518
Practice Address - Fax:770-428-4391
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist