Provider Demographics
NPI:1184626038
Name:MOAK, THOMAS ANDREW III (DPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:MOAK
Suffix:III
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WARWICK WAY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-6145
Mailing Address - Country:US
Mailing Address - Phone:865-579-1852
Mailing Address - Fax:
Practice Address - Street 1:3588 WORKMAN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5932
Practice Address - Country:US
Practice Address - Phone:865-558-8733
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC7809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist