Provider Demographics
NPI:1326312166
Name:FITZGERALD, THOMAS HENRY (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:FITZGERALD
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 1:9925 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2253
Mailing Address - Country:US
Mailing Address - Phone:360-653-0733
Mailing Address - Fax:360-653-0742
Practice Address - Street 1:9925 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2253
Practice Address - Country:US
Practice Address - Phone:360-653-0733
Practice Address - Fax:360-653-0742
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist