Provider Demographics
NPI:1346851151
Name:MAN, THO (PHARMD)
Entity Type:Individual
Prefix:
First Name:THO
Middle Name:
Last Name:MAN
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 1:203 W FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-4809
Mailing Address - Country:US
Mailing Address - Phone:903-572-0486
Mailing Address - Fax:
Practice Address - Street 1:203 W FERGUSON RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-4809
Practice Address - Country:US
Practice Address - Phone:903-572-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist