Provider Demographics
NPI:1346237781
Name:DEAN, THOMAS V (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:V
Last Name:DEAN
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 1:11302 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7907
Mailing Address - Country:US
Mailing Address - Phone:515-334-7608
Mailing Address - Fax:515-334-7610
Practice Address - Street 1:11302 AURORA AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7907
Practice Address - Country:US
Practice Address - Phone:515-334-7608
Practice Address - Fax:515-334-7610
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist