Provider Demographics
NPI:1346470119
Name:PEMBERTON, THOMAS PAUL II (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAUL
Last Name:PEMBERTON
Suffix:II
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 S DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-2608
Mailing Address - Country:US
Mailing Address - Phone:865-354-1140
Mailing Address - Fax:
Practice Address - Street 1:465 S DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-2608
Practice Address - Country:US
Practice Address - Phone:865-354-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist