Provider Demographics
NPI:1396738985
Name:DE PUE, TOM (RPH)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:DE PUE
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 1:140 OLD WOODS RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-8726
Mailing Address - Country:US
Mailing Address - Phone:814-375-0680
Mailing Address - Fax:814-375-5007
Practice Address - Street 1:20 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3842
Practice Address - Country:US
Practice Address - Phone:814-375-5005
Practice Address - Fax:814-375-5007
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-035912-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist