Provider Demographics
NPI:1811277650
Name:BRACKINS, TODD WILSON (PHARMD)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:WILSON
Last Name:BRACKINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CLAIR CV
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8656
Mailing Address - Country:US
Mailing Address - Phone:501-593-3519
Mailing Address - Fax:501-279-5552
Practice Address - Street 1:103 CLAIR CV
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8656
Practice Address - Country:US
Practice Address - Phone:501-593-3519
Practice Address - Fax:501-279-5552
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR74581835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric