Provider Demographics
NPI:1720374820
Name:COYLE, THOMAS MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:COYLE
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 1:2300 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:T-1252
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3722
Mailing Address - Country:US
Mailing Address - Phone:937-436-4096
Mailing Address - Fax:937-435-4096
Practice Address - Street 1:2300 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:T-1252
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3722
Practice Address - Country:US
Practice Address - Phone:937-436-4096
Practice Address - Fax:937-435-4096
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist