Provider Demographics
NPI:1043547086
Name:BWISA, THOMAS S (PHARM D)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:BWISA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7898
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8600 CAMP BOWIE W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6102
Practice Address - Country:US
Practice Address - Phone:817-244-0465
Practice Address - Fax:817-244-1939
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist