Provider Demographics
NPI:1770221236
Name:WETHERILL, TODD MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:WETHERILL
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 1:763 MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8132
Mailing Address - Country:US
Mailing Address - Phone:614-935-2840
Mailing Address - Fax:
Practice Address - Street 1:3282 TREMONT RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-2040
Practice Address - Country:US
Practice Address - Phone:614-326-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03317032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty