Provider Demographics
NPI:1114137882
Name:VERHAGE, THOMAS NELSON (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:NELSON
Last Name:VERHAGE
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 1:4528 CARRICK AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4526
Mailing Address - Country:US
Mailing Address - Phone:616-532-3934
Mailing Address - Fax:616-532-1143
Practice Address - Street 1:6680 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7030
Practice Address - Country:US
Practice Address - Phone:616-554-1964
Practice Address - Fax:616-554-3140
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist