Provider Demographics
NPI:1023177185
Name:CHRONISTER, THOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:CHRONISTER
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 1:440 KERR IS N
Mailing Address - Street 2:
Mailing Address - City:ROME CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46784-9675
Mailing Address - Country:US
Mailing Address - Phone:260-637-6785
Mailing Address - Fax:
Practice Address - Street 1:318 W NORTH ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1004
Practice Address - Country:US
Practice Address - Phone:260-347-0660
Practice Address - Fax:260-347-3638
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist