Provider Demographics
NPI:1689958167
Name:EDMONS, THOMAS LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEE
Last Name:EDMONS
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 1:22257 W HONEY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3302
Mailing Address - Country:US
Mailing Address - Phone:847-800-8043
Mailing Address - Fax:847-847-7936
Practice Address - Street 1:22257 W HONEY RIDGE CT
Practice Address - Street 2:
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-3302
Practice Address - Country:US
Practice Address - Phone:847-800-8043
Practice Address - Fax:847-847-7936
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05132040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist