Provider Demographics
NPI:1891792891
Name:THOMAS, TERRY CLARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:CLARK
Last Name:THOMAS
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 1:5823 BOB GALBREATH RD
Mailing Address - Street 2:PO BOX 946
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-9558
Mailing Address - Country:US
Mailing Address - Phone:360-341-2276
Mailing Address - Fax:
Practice Address - Street 1:11042 SR 525
Practice Address - Street 2:SUITE 130
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8618
Practice Address - Country:US
Practice Address - Phone:360-341-3885
Practice Address - Fax:360-341-3886
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00021826OtherPHARMACY LICENSE