Provider Demographics
NPI:1558321588
Name:HALTERMAN, THOMAS L (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:HALTERMAN
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 1:2613 COUNTRY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7643
Mailing Address - Country:US
Mailing Address - Phone:515-221-9530
Mailing Address - Fax:
Practice Address - Street 1:601 E LOCUST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1945
Practice Address - Country:US
Practice Address - Phone:515-237-0001
Practice Address - Fax:515-237-0002
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist