Provider Demographics
NPI:1609479732
Name:CORWIN, THOMAS ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:CORWIN
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 1:225 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-8564
Mailing Address - Country:US
Mailing Address - Phone:570-620-9727
Mailing Address - Fax:
Practice Address - Street 1:3910 ADLER PL STE 210
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9299
Practice Address - Country:US
Practice Address - Phone:484-860-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033261T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist