Provider Demographics
NPI:1124001813
Name:DONNELLY, TODD MICHAEL (RPH, MS, MBA)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:MICHAEL
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:RPH, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13370 WALNUT TRCE
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9350
Mailing Address - Country:US
Mailing Address - Phone:440-554-5004
Mailing Address - Fax:
Practice Address - Street 1:8333 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-6134
Practice Address - Country:US
Practice Address - Phone:440-554-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-20684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist