Provider Demographics
NPI:1437754868
Name:MALE, THOMAS GERARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GERARD
Last Name:MALE
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 1:20240 ALDER RD
Mailing Address - Street 2:
Mailing Address - City:MONTE RIO
Mailing Address - State:CA
Mailing Address - Zip Code:95462-9787
Mailing Address - Country:US
Mailing Address - Phone:415-385-8988
Mailing Address - Fax:
Practice Address - Street 1:16251 MAIN ST
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-8300
Practice Address - Country:US
Practice Address - Phone:707-869-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty