Provider Demographics
NPI:1093028136
Name:POOLE, THOMAS RAYMOND (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RAYMOND
Last Name:POOLE
Suffix:
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 1:925 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2327
Mailing Address - Country:US
Mailing Address - Phone:724-266-7664
Mailing Address - Fax:724-266-3204
Practice Address - Street 1:925 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2327
Practice Address - Country:US
Practice Address - Phone:724-266-7664
Practice Address - Fax:724-266-3204
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027411L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist