Provider Demographics
NPI:1164734729
Name:THIEROLF, THOMAS DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DEAN
Last Name:THIEROLF
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 1:350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1316
Mailing Address - Country:US
Mailing Address - Phone:215-679-4411
Mailing Address - Fax:215-679-0766
Practice Address - Street 1:350 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1316
Practice Address - Country:US
Practice Address - Phone:215-679-4411
Practice Address - Fax:215-679-0766
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030284L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist