Provider Demographics
NPI:1851046205
Name:NELSON, TODD PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:PAUL
Last Name:NELSON
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 1:1010 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-2577
Mailing Address - Country:US
Mailing Address - Phone:320-339-1481
Mailing Address - Fax:
Practice Address - Street 1:161 GLEN STREET
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329
Practice Address - Country:US
Practice Address - Phone:320-968-8625
Practice Address - Fax:320-968-4055
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist