Provider Demographics
NPI:1194776252
Name:SIRO, THOMAS P (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:SIRO
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 1:104 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-1606
Mailing Address - Country:US
Mailing Address - Phone:570-385-5779
Mailing Address - Fax:570-385-3015
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-1606
Practice Address - Country:US
Practice Address - Phone:570-385-5779
Practice Address - Fax:570-385-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030255L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA19104625601Medicaid