Provider Demographics
NPI:1881806321
Name:CANADA, TODD WAYNE (PHARMD, BCNSP)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:WAYNE
Last Name:CANADA
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Gender:M
Credentials:PHARMD, BCNSP
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Mailing Address - Street 1:1515 HOLCOMBE BOULEVARD, UNIT 377
Mailing Address - Street 2:DIVISION OF PHARMACY
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4009
Mailing Address - Country:US
Mailing Address - Phone:713-745-0685
Mailing Address - Fax:713-794-4399
Practice Address - Street 1:1515 HOLCOMBE BOULEVARD, UNIT 377
Practice Address - Street 2:DIVISION OF PHARMACY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-745-0685
Practice Address - Fax:713-794-4399
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX304281835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support