Provider Demographics
NPI:1831305317
Name:DUESBOUT, THOMAS EDWARD II (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:DUESBOUT
Suffix:II
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 1:9910 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:MI
Mailing Address - Zip Code:48435-9752
Mailing Address - Country:US
Mailing Address - Phone:989-795-2020
Mailing Address - Fax:
Practice Address - Street 1:625 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1543
Practice Address - Country:US
Practice Address - Phone:989-673-6852
Practice Address - Fax:989-673-1614
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist