Provider Demographics
NPI:1871869859
Name:KELEHER, THOMAS L (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:KELEHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:L
Other - Last Name:KELEHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3858 CASS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1814
Mailing Address - Country:US
Mailing Address - Phone:402-651-4697
Mailing Address - Fax:402-556-7392
Practice Address - Street 1:3858 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1814
Practice Address - Country:US
Practice Address - Phone:402-651-4697
Practice Address - Fax:402-556-7392
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13241183500000X
NE7731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist