Provider Demographics
NPI:1730298894
Name:TODD, MARY BENSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BENSON
Last Name:TODD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 KELSEY LN
Mailing Address - Street 2:PROFESSIONAL SERVICES DEPARTMENT
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4336
Mailing Address - Country:US
Mailing Address - Phone:813-318-6776
Mailing Address - Fax:813-627-2403
Practice Address - Street 1:175 KELSEY LN
Practice Address - Street 2:PROFESSIONAL SERVICES DEPARTMENT
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4336
Practice Address - Country:US
Practice Address - Phone:813-318-6776
Practice Address - Fax:813-627-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 34237183500000X
MD15725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist