Provider Demographics
NPI:1467720466
Name:LALE, THOMAS
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BRANSON HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9943
Mailing Address - Country:US
Mailing Address - Phone:417-243-4513
Mailing Address - Fax:
Practice Address - Street 1:1200 BRANSON HILLS PKWY
Practice Address - Street 2:T2098
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9943
Practice Address - Country:US
Practice Address - Phone:417-243-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist