Provider Demographics
NPI:1013780899
Name:GRIFFIN, THOMAS J (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:GRIFFIN
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 1:12822 CRESTMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8113
Mailing Address - Country:US
Mailing Address - Phone:407-701-4988
Mailing Address - Fax:
Practice Address - Street 1:805 N WHITTINGTON PKWY STE 400
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-7102
Practice Address - Country:US
Practice Address - Phone:502-627-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist