Provider Demographics
NPI:1518247717
Name:SPERRY, THOMAS KIRK (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:KIRK
Last Name:SPERRY
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 1:828 DELBON AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2005
Mailing Address - Country:US
Mailing Address - Phone:209-634-8511
Mailing Address - Fax:209-634-3839
Practice Address - Street 1:828 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2005
Practice Address - Country:US
Practice Address - Phone:209-634-8511
Practice Address - Fax:209-634-3839
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist