Provider Demographics
NPI:1932394467
Name:STENSLAND, THOMAS G (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:STENSLAND
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 1:2351 MAIN ST SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6320
Mailing Address - Country:US
Mailing Address - Phone:505-865-2089
Mailing Address - Fax:505-865-2829
Practice Address - Street 1:2351 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6320
Practice Address - Country:US
Practice Address - Phone:505-865-2089
Practice Address - Fax:505-865-2829
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00003844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist