Provider Demographics
NPI:1023241130
Name:CREMONA, THOMAS (PD,CN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CREMONA
Suffix:
Gender:M
Credentials:PD,CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 TURKEY LANE RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:ME
Mailing Address - Zip Code:04253-4204
Mailing Address - Country:US
Mailing Address - Phone:207-897-4979
Mailing Address - Fax:207-897-4979
Practice Address - Street 1:124 TURKEY LANE RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:ME
Practice Address - Zip Code:04253-4204
Practice Address - Country:US
Practice Address - Phone:207-897-4979
Practice Address - Fax:207-897-4979
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR52411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist