Provider Demographics
NPI:1033250295
Name:NELSON, THOMAS L (RPH PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:NELSON
Suffix:
Gender:M
Credentials:RPH PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511
Mailing Address - Country:US
Mailing Address - Phone:608-365-1797
Mailing Address - Fax:608-364-1094
Practice Address - Street 1:20 PARK AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-362-6012
Practice Address - Fax:608-364-1094
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist