Provider Demographics
NPI:1740478361
Name:EWERS, THOMAS JEFFREY (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFREY
Last Name:EWERS
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 1:523 SAN GERONIMO RD
Mailing Address - Street 2:#13
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6456
Mailing Address - Country:US
Mailing Address - Phone:515-897-0201
Mailing Address - Fax:
Practice Address - Street 1:523 SAN GERONIMO RD
Practice Address - Street 2:#13
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6456
Practice Address - Country:US
Practice Address - Phone:515-897-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14746183500000X
FLPS 40074183500000X
MO043286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist