Provider Demographics
NPI:1083840789
Name:DOAK, THOMAS M (R PH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:DOAK
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:PINE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14872-9703
Mailing Address - Country:US
Mailing Address - Phone:607-732-1575
Mailing Address - Fax:
Practice Address - Street 1:500 S MEADOW ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5317
Practice Address - Country:US
Practice Address - Phone:607-277-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist