Provider Demographics
NPI:1881779460
Name:CLARENCE, THOMAS EDWARD (RPH, MS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:CLARENCE
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:MR
Other - First Name:LAWRENCE
Other - Middle Name:NAPOLES
Other - Last Name:TIMBAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:20 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641
Mailing Address - Country:US
Mailing Address - Phone:802-479-3381
Mailing Address - Fax:802-479-0640
Practice Address - Street 1:20 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-479-3381
Practice Address - Fax:802-479-0640
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0062522183500000X
VT033.0123144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist