Provider Demographics
NPI:1396126629
Name:KIBUTHU, THOMAS N (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:N
Last Name:KIBUTHU
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 1:2728 E FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-3815
Mailing Address - Country:US
Mailing Address - Phone:443-839-5118
Mailing Address - Fax:
Practice Address - Street 1:2728 E FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-3815
Practice Address - Country:US
Practice Address - Phone:443-839-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178061163W00000X
MD23165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse