Provider Demographics
NPI:1811272651
Name:KEARNEY, THOMAS WENDLE (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WENDLE
Last Name:KEARNEY
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 1:19 E FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-6420
Mailing Address - Country:US
Mailing Address - Phone:410-625-1817
Mailing Address - Fax:410-625-4376
Practice Address - Street 1:19 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-6420
Practice Address - Country:US
Practice Address - Phone:410-625-1817
Practice Address - Fax:410-625-4376
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist