Provider Demographics
NPI:1972274942
Name:COX, THOMAS ROGER
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROGER
Last Name:COX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-7704
Mailing Address - Country:US
Mailing Address - Phone:937-663-6001
Mailing Address - Fax:
Practice Address - Street 1:122 S SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-7704
Practice Address - Country:US
Practice Address - Phone:937-663-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03110856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist