Provider Demographics
NPI:1689906844
Name:COLLIGAN, THOMAS HENRY IV (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HENRY
Last Name:COLLIGAN
Suffix:IV
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHIPMUNK CT
Mailing Address - Street 2:
Mailing Address - City:SCHAGHTICOKE
Mailing Address - State:NY
Mailing Address - Zip Code:12154-2702
Mailing Address - Country:US
Mailing Address - Phone:518-753-4532
Mailing Address - Fax:
Practice Address - Street 1:1549 ROUTE 9
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-373-5732
Practice Address - Fax:518-373-5753
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist