Provider Demographics
NPI:1316493109
Name:RESTER, THOMAS EDWIN (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWIN
Last Name:RESTER
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 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339
Mailing Address - Country:US
Mailing Address - Phone:662-773-5222
Mailing Address - Fax:662-773-9951
Practice Address - Street 1:104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2620
Practice Address - Country:US
Practice Address - Phone:662-773-5222
Practice Address - Fax:662-773-9951
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-05249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist