Provider Demographics
NPI:1255748844
Name:FOLSOM, TONY R (RPH)
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:R
Last Name:FOLSOM
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 1:400 AMES ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-3099
Mailing Address - Country:US
Mailing Address - Phone:785-594-0340
Mailing Address - Fax:785-594-0343
Practice Address - Street 1:400 AMES ST
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-3099
Practice Address - Country:US
Practice Address - Phone:785-594-0340
Practice Address - Fax:785-594-0343
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-10630OtherPHARMACIST