Provider Demographics
NPI:1417003724
Name:MIDDLEBROOKS, THOMAS A (BSPHARMACY)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:MIDDLEBROOKS
Suffix:
Gender:M
Credentials:BSPHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 YORKTOWN LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2546
Mailing Address - Country:US
Mailing Address - Phone:540-786-0444
Mailing Address - Fax:
Practice Address - Street 1:4901 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6625
Practice Address - Country:US
Practice Address - Phone:540-786-3008
Practice Address - Fax:540-786-1931
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202003977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist