Provider Demographics
NPI:1740815067
Name:KINES, TOM PATRICK
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:PATRICK
Last Name:KINES
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 1:6097 SISSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-9595
Mailing Address - Country:US
Mailing Address - Phone:304-984-1001
Mailing Address - Fax:304-984-1121
Practice Address - Street 1:6097 SISSONVILLE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-9595
Practice Address - Country:US
Practice Address - Phone:304-984-1001
Practice Address - Fax:304-984-1121
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP5118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist