Provider Demographics
NPI:1932237112
Name:NELSON, THOMAS E (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:NELSON
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 1:2402 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DONNELLSON
Mailing Address - State:IA
Mailing Address - Zip Code:52625-9160
Mailing Address - Country:US
Mailing Address - Phone:319-835-9065
Mailing Address - Fax:
Practice Address - Street 1:2404 AVENUE L
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-3933
Practice Address - Country:US
Practice Address - Phone:319-372-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist