Provider Demographics
NPI:1801530308
Name:POE, THOMAS CHRISTOPHER (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:POE
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 1:155 DALE DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1235
Mailing Address - Country:US
Mailing Address - Phone:608-234-1293
Mailing Address - Fax:
Practice Address - Street 1:3250 KINGSLEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4628
Practice Address - Country:US
Practice Address - Phone:608-310-9922
Practice Address - Fax:608-442-8490
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12580-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist