Provider Demographics
NPI:1881219020
Name:OLBERDING, THOMAS GERARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GERARD
Last Name:OLBERDING
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 1:1020 12TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-1919
Mailing Address - Country:US
Mailing Address - Phone:563-875-7455
Mailing Address - Fax:
Practice Address - Street 1:1020 12TH AVE SE
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1919
Practice Address - Country:US
Practice Address - Phone:563-875-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist