Provider Demographics
NPI:1275170029
Name:SHRACK, THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHRACK
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 1:1500 W MCGALLIARD RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2203
Mailing Address - Country:US
Mailing Address - Phone:765-748-2826
Mailing Address - Fax:
Practice Address - Street 1:1500 W MCGALLIARD RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2203
Practice Address - Country:US
Practice Address - Phone:765-741-1494
Practice Address - Fax:765-741-1496
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027244A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist