Provider Demographics
NPI:1609903095
Name:MONTGOMERY, THOMAS J (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:MONTGOMERY
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 1:484 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17737-1812
Mailing Address - Country:US
Mailing Address - Phone:570-584-2005
Mailing Address - Fax:
Practice Address - Street 1:49 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-1213
Practice Address - Country:US
Practice Address - Phone:570-584-2005
Practice Address - Fax:570-584-5115
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032440L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist