Provider Demographics
NPI:1790758225
Name:MARCROM, THOMAS H (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:MARCROM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 DOAK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-7360
Mailing Address - Country:US
Mailing Address - Phone:931-728-0472
Mailing Address - Fax:
Practice Address - Street 1:1277 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2423
Practice Address - Country:US
Practice Address - Phone:931-728-1100
Practice Address - Fax:931-723-4137
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-5354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist