Provider Demographics
NPI:1558924589
Name:TOMLINSON, CHARLES THURSTON
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THURSTON
Last Name:TOMLINSON
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 1:11778 AMOS GATES DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1176
Mailing Address - Country:US
Mailing Address - Phone:402-319-4025
Mailing Address - Fax:
Practice Address - Street 1:825 N 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2702
Practice Address - Country:US
Practice Address - Phone:402-614-6363
Practice Address - Fax:402-505-4397
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist