Provider Demographics
NPI:1366765281
Name:ABBRUSCATO, THOMAS J (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:ABBRUSCATO
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 1:33 EVELYN CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2812
Mailing Address - Country:US
Mailing Address - Phone:631-399-4346
Mailing Address - Fax:
Practice Address - Street 1:1036 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1606
Practice Address - Country:US
Practice Address - Phone:631-585-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist