Provider Demographics
NPI:1699813048
Name:HOUGH, THOMAS W (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:HOUGH
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 1:609 MORVEN RD
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2746
Mailing Address - Country:US
Mailing Address - Phone:704-694-4990
Mailing Address - Fax:704-694-9376
Practice Address - Street 1:806 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2642
Practice Address - Country:US
Practice Address - Phone:704-694-9358
Practice Address - Fax:704-694-9376
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0045138Medicaid
SC7N4842Medicaid
NC0045138Medicaid