Provider Demographics
NPI:1104358290
Name:TOLAND, THEODORE (RPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:TOLAND
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 1:4000 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3528
Mailing Address - Country:US
Mailing Address - Phone:989-839-9975
Mailing Address - Fax:989-839-1010
Practice Address - Street 1:4000 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3528
Practice Address - Country:US
Practice Address - Phone:989-839-9975
Practice Address - Fax:989-839-1010
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist