Provider Demographics
NPI:1518374677
Name:PENN, TODD ANTHONY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANTHONY
Last Name:PENN
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 1:4330 TIMBER RIDGE TRL SW APT 10
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4298
Mailing Address - Country:US
Mailing Address - Phone:480-309-7636
Mailing Address - Fax:
Practice Address - Street 1:4330 TIMBER RIDGE TRL SW
Practice Address - Street 2:APT. 10
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-6426
Practice Address - Country:US
Practice Address - Phone:480-309-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist