Provider Demographics
NPI:1477877686
Name:OLDS, THOMAS KEVIN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEVIN
Last Name:OLDS
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 1:6020 B DR N
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-8367
Mailing Address - Country:US
Mailing Address - Phone:269-979-4727
Mailing Address - Fax:
Practice Address - Street 1:6020 B DR N
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8367
Practice Address - Country:US
Practice Address - Phone:269-979-4727
Practice Address - Fax:269-979-8704
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302026393OtherSTATE OF MICHIGAN - DEPARTMENT OF COMMUNITY HEALTH