Provider Demographics
NPI:1447694963
Name:THOMAS, THOMAS MERRILL (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MERRILL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:MERRILL
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:230 N WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2735
Mailing Address - Country:US
Mailing Address - Phone:920-336-2323
Mailing Address - Fax:920-336-2186
Practice Address - Street 1:230 N WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2735
Practice Address - Country:US
Practice Address - Phone:920-336-2323
Practice Address - Fax:920-336-2186
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7260-401835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy