Provider Demographics
NPI:1689852527
Name:KUZMA, THOMAS MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:KUZMA
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 1:454 FORT SALONGA RD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3047
Mailing Address - Country:US
Mailing Address - Phone:631-757-4832
Mailing Address - Fax:631-757-4971
Practice Address - Street 1:454 FORT SALONGA RD
Practice Address - Street 2:PHARMACY
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3047
Practice Address - Country:US
Practice Address - Phone:631-757-4832
Practice Address - Fax:631-757-4971
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02839036Medicare Oscar/Certification