Provider Demographics
NPI:1174807192
Name:SMITH, THOMAS EDWARD JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:SMITH
Suffix:JR
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 1:517 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901
Mailing Address - Country:US
Mailing Address - Phone:513-350-5504
Mailing Address - Fax:
Practice Address - Street 1:12 N ABE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6361
Practice Address - Country:US
Practice Address - Phone:325-658-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist