Provider Demographics
NPI:1881682151
Name:MAIN, THOMAS ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALLEN
Last Name:MAIN
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 1:302 PRAIRIE ST N
Mailing Address - Street 2:PO BOX 432
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-1417
Mailing Address - Country:US
Mailing Address - Phone:334-738-2020
Mailing Address - Fax:334-738-8050
Practice Address - Street 1:302 PRAIRIE ST N
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1417
Practice Address - Country:US
Practice Address - Phone:334-738-2020
Practice Address - Fax:334-738-8050
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13762OtherPHARMACY LICENSE
FL38670OtherPHARMACY LICENSE