Provider Demographics
NPI:1568749638
Name:WERTISH, TODD
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:WERTISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 W DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2125
Mailing Address - Country:US
Mailing Address - Phone:623-572-7487
Mailing Address - Fax:623-572-8024
Practice Address - Street 1:8240 W DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2125
Practice Address - Country:US
Practice Address - Phone:623-572-7487
Practice Address - Fax:623-572-8024
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist