Provider Demographics
NPI:1629148507
Name:CUOMO, THOMAS E (CPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:CUOMO
Suffix:
Gender:M
Credentials:CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 EAGLES LANDING CIR W
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2800
Mailing Address - Country:US
Mailing Address - Phone:239-851-1903
Mailing Address - Fax:
Practice Address - Street 1:3033 EAGLES LANDING CIR W
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2800
Practice Address - Country:US
Practice Address - Phone:239-851-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU42861835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688324996Medicaid