Provider Demographics
NPI:1649878018
Name:WARWICK, THOMAS ROBERT
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:WARWICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E10047A BUCK BAY W
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-9629
Mailing Address - Country:US
Mailing Address - Phone:608-393-1547
Mailing Address - Fax:
Practice Address - Street 1:130 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-8263
Practice Address - Country:US
Practice Address - Phone:608-253-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10034-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist