Provider Demographics
NPI:1366706186
Name:BULLOCK, THOMAS KELTON JR (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:KELTON
Last Name:BULLOCK
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10097 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-5777
Mailing Address - Country:US
Mailing Address - Phone:228-216-2501
Mailing Address - Fax:
Practice Address - Street 1:703 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3542
Practice Address - Country:US
Practice Address - Phone:251-200-5750
Practice Address - Fax:251-200-5725
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD07327183500000X
AL17582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist