Provider Demographics
NPI:1578545455
Name:MOONEY, THOMAS ROUSE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ROUSE
Last Name:MOONEY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 CAMELOT CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2937
Mailing Address - Country:US
Mailing Address - Phone:423-282-3263
Mailing Address - Fax:423-926-6222
Practice Address - Street 1:1107 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3901
Practice Address - Country:US
Practice Address - Phone:423-926-7333
Practice Address - Fax:423-926-6222
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist