Provider Demographics
NPI:1174616221
Name:THOME ENTERPRISE L L C
Entity type:Organization
Organization Name:THOME ENTERPRISE L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-697-6125
Mailing Address - Street 1:119 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1430
Mailing Address - Country:US
Mailing Address - Phone:509-697-6125
Mailing Address - Fax:509-697-9399
Practice Address - Street 1:119 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1430
Practice Address - Country:US
Practice Address - Phone:509-697-6125
Practice Address - Fax:509-697-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601963838332B00000X, 3336C0003X, 335E00000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601963838OtherUBI NUMBER
WA4901713OtherNABP NUMBER
WA6016000Medicaid
WA6016000Medicaid