Provider Demographics
NPI:1811178049
Name:NIES, THOMAS C (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:NIES
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 1:1107 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1993
Mailing Address - Country:US
Mailing Address - Phone:765-482-7879
Mailing Address - Fax:
Practice Address - Street 1:112 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2151
Practice Address - Country:US
Practice Address - Phone:765-482-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist