Provider Demographics
NPI:1720162068
Name:THOMAS A CHRISTIANSON
Entity Type:Organization
Organization Name:THOMAS A CHRISTIANSON
Other - Org Name:RHYME DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-742-3737
Mailing Address - Street 1:117 E COOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-2204
Mailing Address - Country:US
Mailing Address - Phone:608-742-3737
Mailing Address - Fax:608-742-0216
Practice Address - Street 1:117 E COOK ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2204
Practice Address - Country:US
Practice Address - Phone:608-742-3737
Practice Address - Fax:608-742-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9631-040183500000X
WI6336332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33054700Medicaid
0160450001Medicare UPIN
WI0160450001Medicare ID - Type Unspecified