Provider Demographics
NPI:1356635551
Name:GAGE, THOMAS BENTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BENTON
Last Name:GAGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7014 FM 78
Mailing Address - Street 2:T-2452
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1758
Mailing Address - Country:US
Mailing Address - Phone:210-424-3005
Mailing Address - Fax:210-424-3015
Practice Address - Street 1:7014 FM 78
Practice Address - Street 2:T-2452
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1758
Practice Address - Country:US
Practice Address - Phone:210-424-3005
Practice Address - Fax:210-424-3015
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist