Provider Demographics
NPI:1295758852
Name:THOMAS, ANDREW O (RPH)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:O
Last Name:THOMAS
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 1:327 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEYERSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15552-1035
Mailing Address - Country:US
Mailing Address - Phone:814-634-8614
Mailing Address - Fax:814-634-0827
Practice Address - Street 1:327 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEYERSDALE
Practice Address - State:PA
Practice Address - Zip Code:15552-1035
Practice Address - Country:US
Practice Address - Phone:814-634-8614
Practice Address - Fax:814-634-0827
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042666L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3911319OtherNCPDP NUMBER
PA0008198010003Medicaid
PA1238390001Medicare ID - Type Unspecified