Provider Demographics
NPI:1336321371
Name:BULL, THOMAS WILBUR FORESTER (RPH, PED)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILBUR FORESTER
Last Name:BULL
Suffix:
Gender:M
Credentials:RPH, PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 DEBBIE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7612
Mailing Address - Country:US
Mailing Address - Phone:262-547-3552
Mailing Address - Fax:
Practice Address - Street 1:13935 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2496
Practice Address - Country:US
Practice Address - Phone:262-781-7410
Practice Address - Fax:262-781-7497
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12992-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12992-040OtherWI PHARMACY LICENSE