Provider Demographics
NPI:1255771663
Name:MOON, THOMAS COLT (PHARMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:COLT
Last Name:MOON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E KEN PRATT BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8500
Mailing Address - Country:US
Mailing Address - Phone:303-827-2544
Mailing Address - Fax:303-827-2535
Practice Address - Street 1:205 E KEN PRATT BLVD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8500
Practice Address - Country:US
Practice Address - Phone:303-827-2544
Practice Address - Fax:303-827-2535
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53041183500000X
COPHA.0024226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist