Provider Demographics
NPI:1063623643
Name:HUMPHREYS, THOMAS W (BS PHARM)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3087
Mailing Address - Country:US
Mailing Address - Phone:614-890-8869
Mailing Address - Fax:614-890-1193
Practice Address - Street 1:55 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3087
Practice Address - Country:US
Practice Address - Phone:614-890-8869
Practice Address - Fax:614-890-1193
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist