Provider Demographics
NPI:1578852679
Name:VANDEUSEN, THOMAS LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEIGH
Last Name:VANDEUSEN
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 1:2175 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2405
Mailing Address - Country:US
Mailing Address - Phone:203-288-3895
Mailing Address - Fax:203-281-4113
Practice Address - Street 1:2175 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2405
Practice Address - Country:US
Practice Address - Phone:203-288-3895
Practice Address - Fax:203-281-4113
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0007341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist