Provider Demographics
NPI:1730672817
Name:RASMUSSEN, THOMAS RON
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RON
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:RON
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:16 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-1702
Mailing Address - Country:US
Mailing Address - Phone:641-210-1276
Mailing Address - Fax:641-394-4155
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-2101
Practice Address - Country:US
Practice Address - Phone:641-394-4156
Practice Address - Fax:641-394-4155
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist