Provider Demographics
NPI:1225395569
Name:BREWER, THOMAS STEPHEN (EMT, PHARMACY TECH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:BREWER
Suffix:
Gender:M
Credentials:EMT, PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CELANTANO DR
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-5214
Mailing Address - Country:US
Mailing Address - Phone:203-841-9623
Mailing Address - Fax:
Practice Address - Street 1:63 CELANTANO DR
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-5214
Practice Address - Country:US
Practice Address - Phone:203-841-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004299146N00000X
CT0002476183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0002476OtherPHARMACY TECH
CT004299OtherEMERGENCY MEDICAL TECHNICIAN