Individual
DR. TODD SUPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D., BCPS
Contact information
Practice address
451 HEALTH PKWY, PAW PAW, MI 49079
(269) 655-1735
Mailing address
451 HEALTH PKWY STE F, PAW PAW, MI 49079-8242
(269) 655-1735
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
5302036387
MI
1835P1200X
Pharmacotherapy Pharmacist
5302036387
MI
1835P2201X
Ambulatory Care Pharmacist
Primary
5302036387
MI
Other
Enumeration date
07/31/2014
Last updated
07/10/2018
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