Provider Demographics
NPI:1871840256
Name:MACLEAN, THOMAS A JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:MACLEAN
Suffix:JR
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 1:5500 HOHMAN AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1965
Mailing Address - Country:US
Mailing Address - Phone:219-937-3467
Mailing Address - Fax:219-937-3672
Practice Address - Street 1:5500 HOHMAN AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1965
Practice Address - Country:US
Practice Address - Phone:219-937-3467
Practice Address - Fax:219-937-3672
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019397A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist