Provider Demographics
NPI:1760071682
Name:CHOQUETTE, THOMAS LYNN
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LYNN
Last Name:CHOQUETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0087
Mailing Address - Country:US
Mailing Address - Phone:402-984-2092
Mailing Address - Fax:402-462-4180
Practice Address - Street 1:1021 W 14TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3046
Practice Address - Country:US
Practice Address - Phone:402-462-4466
Practice Address - Fax:402-462-4180
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist