Provider Demographics
NPI:1922628734
Name:GILMORE, THOMAS ADAM (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ADAM
Last Name:GILMORE
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 1:24 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2314
Mailing Address - Country:US
Mailing Address - Phone:860-944-0516
Mailing Address - Fax:
Practice Address - Street 1:24 TERRACE DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2314
Practice Address - Country:US
Practice Address - Phone:860-944-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0007778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.0007778OtherRPH LICENSE