Provider Demographics
NPI:1487271136
Name:DEVANEY, THOMAS J (PHARMACIST)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:DEVANEY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:DEVANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:303 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1190
Mailing Address - Country:US
Mailing Address - Phone:319-462-3306
Mailing Address - Fax:319-462-6065
Practice Address - Street 1:303 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1190
Practice Address - Country:US
Practice Address - Phone:319-462-3306
Practice Address - Fax:319-462-6065
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty