Provider Demographics
NPI:1235561150
Name:GANNON, THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GANNON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 E 350
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-6509
Mailing Address - Country:US
Mailing Address - Phone:816-358-5988
Mailing Address - Fax:816-358-6885
Practice Address - Street 1:9400 E 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-6509
Practice Address - Country:US
Practice Address - Phone:816-358-5988
Practice Address - Fax:816-358-6885
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007028072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist