Provider Demographics
NPI:1780133165
Name:CERNY, THOMAS NORBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:NORBERT
Last Name:CERNY
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 1:374 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3962
Mailing Address - Country:US
Mailing Address - Phone:618-453-4417
Mailing Address - Fax:618-453-4672
Practice Address - Street 1:374 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3962
Practice Address - Country:US
Practice Address - Phone:618-453-4417
Practice Address - Fax:618-453-4672
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510367151835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care