Provider Demographics
NPI:1831453497
Name:VISCO, THOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:VISCO
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 1:250 NEW RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2177
Mailing Address - Country:US
Mailing Address - Phone:609-653-8378
Mailing Address - Fax:609-653-9326
Practice Address - Street 1:250 NEW RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2177
Practice Address - Country:US
Practice Address - Phone:609-653-8378
Practice Address - Fax:609-653-9326
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031992L183500000X
NJ28RI02105900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist