Provider Demographics
NPI:1164962403
Name:PILCHER, TOM RONALD (RPH)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:RONALD
Last Name:PILCHER
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 1:306 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-4432
Mailing Address - Country:US
Mailing Address - Phone:386-698-2368
Mailing Address - Fax:386-698-4343
Practice Address - Street 1:306 UNION AVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-4432
Practice Address - Country:US
Practice Address - Phone:386-698-2368
Practice Address - Fax:386-698-4343
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist