Provider Demographics
NPI:1275810673
Name:MARKOWSKI, TODD MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:MARKOWSKI
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:W280N6411 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3382
Mailing Address - Country:US
Mailing Address - Phone:262-352-3162
Mailing Address - Fax:414-328-1543
Practice Address - Street 1:9100 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4422
Practice Address - Country:US
Practice Address - Phone:414-328-1228
Practice Address - Fax:414-328-1543
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12245-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33203800Medicaid
WI33203800Medicaid