Provider Demographics
NPI:1528055910
Name:WARMACK, THOMAS L (PD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:WARMACK
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 GARY LN
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7049
Mailing Address - Country:US
Mailing Address - Phone:870-942-3835
Mailing Address - Fax:870-352-3236
Practice Address - Street 1:908 W 4TH ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-2216
Practice Address - Country:US
Practice Address - Phone:870-352-2161
Practice Address - Fax:870-352-3236
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist