Provider Demographics
NPI:1760561112
Name:BORYSEK, THOMAS HENRY (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:BORYSEK
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-0002
Mailing Address - Country:US
Mailing Address - Phone:708-786-7876
Mailing Address - Fax:708-786-7989
Practice Address - Street 1:BOX 2
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-786-7876
Practice Address - Fax:708-786-7989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist