Provider Demographics
NPI:1437586591
Name:STEWART, THOMAS D JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:STEWART
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 1:2100 W CERVANTES ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-7145
Mailing Address - Country:US
Mailing Address - Phone:850-438-9272
Mailing Address - Fax:
Practice Address - Street 1:2100 W CERVANTES ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-7145
Practice Address - Country:US
Practice Address - Phone:850-438-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR085941835P0018X
FLPS214811835P0018X, 1835P0018X
HI22921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist