Provider Demographics
NPI:1205081908
Name:GAYLORD, THOMAS ARNOLD (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ARNOLD
Last Name:GAYLORD
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0190
Mailing Address - Country:US
Mailing Address - Phone:218-387-1283
Mailing Address - Fax:
Practice Address - Street 1:1036 DEVIL TRACK ROAD
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-0190
Practice Address - Country:US
Practice Address - Phone:218-387-1283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist