Provider Demographics
NPI:1477843498
Name:DREW, THOMAS JONATHAN (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JONATHAN
Last Name:DREW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4595
Mailing Address - Country:US
Mailing Address - Phone:209-577-6060
Mailing Address - Fax:207-577-0879
Practice Address - Street 1:1032 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4595
Practice Address - Country:US
Practice Address - Phone:209-577-6060
Practice Address - Fax:207-577-0879
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist