Provider Demographics
NPI:1255636353
Name:ULRICH, THOMAS (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ULRICH
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 1:3086 W COUNTY ROAD 100 N
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-8532
Mailing Address - Country:US
Mailing Address - Phone:574-753-8309
Mailing Address - Fax:574-583-8778
Practice Address - Street 1:812 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2011
Practice Address - Country:US
Practice Address - Phone:574-583-3706
Practice Address - Fax:574-583-8778
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist