Provider Demographics
NPI:1669945515
Name:MUDD, THOMAS B (PHARMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:MUDD
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 1:1155 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3960
Mailing Address - Country:US
Mailing Address - Phone:762-887-6046
Mailing Address - Fax:762-887-6050
Practice Address - Street 1:1155 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3960
Practice Address - Country:US
Practice Address - Phone:762-887-6046
Practice Address - Fax:762-887-6050
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43175183500000X
NC24751183500000X
GARPH028374183500000X
FLPS42646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24751OtherNORTH CAROLINA BOARD OF PHARMACY
TN43175OtherTENNESSEE BOARD OF PHARMACY
FLPS42646OtherFLORIDA BOARD OF PHARMACY
GARPH028374OtherGEORGIA BOARD OF PHARMACY