Provider Demographics
NPI:1174655757
Name:TODD, JOHN EDWIN III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWIN
Last Name:TODD
Suffix:III
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 1:6119 LOUISVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5327
Mailing Address - Country:US
Mailing Address - Phone:806-786-1303
Mailing Address - Fax:
Practice Address - Street 1:6119 LOUISVILLE DR
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5327
Practice Address - Country:US
Practice Address - Phone:806-786-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist