Provider Demographics
NPI:1992017099
Name:PURCELL, THOMAS DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DOUGLAS
Last Name:PURCELL
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 1:93 JESSIE CV
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7572
Mailing Address - Country:US
Mailing Address - Phone:901-837-3095
Mailing Address - Fax:
Practice Address - Street 1:43 TABB DR
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058-8602
Practice Address - Country:US
Practice Address - Phone:901-840-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist