Provider Demographics
NPI:1518175447
Name:DODDS, THOMAS B
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:B
Last Name:DODDS
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 1:334 W PINEHURST TRL
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5233
Mailing Address - Country:US
Mailing Address - Phone:605-232-6477
Mailing Address - Fax:
Practice Address - Street 1:LEEDS PHARMACY
Practice Address - Street 2:4029 FLOYD BLVD
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51108-1501
Practice Address - Country:US
Practice Address - Phone:712-239-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist