Provider Demographics
NPI:1699807982
Name:HOGAN, THOMAS S SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
Last Name:HOGAN
Suffix:SR
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 1:22331 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-5705
Mailing Address - Country:US
Mailing Address - Phone:352-796-2088
Mailing Address - Fax:
Practice Address - Street 1:22331 POWELL RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-5705
Practice Address - Country:US
Practice Address - Phone:352-796-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist