Provider Demographics
NPI:1093224842
Name:LUNDQUIST, TODD J (PHARMD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:LUNDQUIST
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 1:1450 N 2ND E
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5131
Mailing Address - Country:US
Mailing Address - Phone:208-359-2814
Mailing Address - Fax:208-359-2816
Practice Address - Street 1:1450 N 2ND E
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5131
Practice Address - Country:US
Practice Address - Phone:208-359-2814
Practice Address - Fax:208-359-2816
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7820183500000X
WY4003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist