Provider Demographics
NPI:1245838291
Name:KUDRONOWICZ, TODD JAMES (RPH)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:JAMES
Last Name:KUDRONOWICZ
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 1:1800 PROGRESSIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3800
Mailing Address - Country:US
Mailing Address - Phone:800-400-8569
Mailing Address - Fax:608-348-7809
Practice Address - Street 1:1800 PROGRESSIVE PKWY
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3800
Practice Address - Country:US
Practice Address - Phone:800-400-8569
Practice Address - Fax:608-348-7809
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12389-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist