Provider Demographics
NPI:1245669589
Name:MIEHLKE, TODD JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:JAMES
Last Name:MIEHLKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15023 DUXBURY LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-9321
Mailing Address - Country:US
Mailing Address - Phone:517-290-3138
Mailing Address - Fax:517-347-9165
Practice Address - Street 1:2055 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1706
Practice Address - Country:US
Practice Address - Phone:517-347-9133
Practice Address - Fax:517-347-9165
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4112081835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric