Provider Demographics
NPI:1619251840
Name:LECLAIRE, THOMAS KEITH (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEITH
Last Name:LECLAIRE
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 1:106 N MASSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8118
Mailing Address - Country:US
Mailing Address - Phone:417-724-9568
Mailing Address - Fax:417-724-9576
Practice Address - Street 1:106 N MASSEY BLVD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8118
Practice Address - Country:US
Practice Address - Phone:417-724-9568
Practice Address - Fax:417-724-9576
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist