Provider Demographics
NPI:1447557418
Name:ALTENBERGER, THOMAS PAUL (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PAUL
Last Name:ALTENBERGER
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Gender:M
Credentials:RPH, MBA
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Mailing Address - Street 1:3031 POPLAR CREEK DR SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5682
Mailing Address - Country:US
Mailing Address - Phone:616-975-7590
Mailing Address - Fax:616-975-7596
Practice Address - Street 1:3031 POPLAR CREEK DR SE
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-5682
Practice Address - Country:US
Practice Address - Phone:616-975-7590
Practice Address - Fax:616-975-7596
Is Sole Proprietor?:No
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI53020329921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist