Provider Demographics
NPI:1598365736
Name:ALBERT, THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ALBERT
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 1:3508 TRADEWINDS CV
Mailing Address - Street 2:
Mailing Address - City:REMINDERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9097
Mailing Address - Country:US
Mailing Address - Phone:216-534-2604
Mailing Address - Fax:
Practice Address - Street 1:25101 CHAGRIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5694
Practice Address - Country:US
Practice Address - Phone:216-245-4468
Practice Address - Fax:216-685-4671
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03316900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03316900OtherPHARMACY LICENSE