Provider Demographics
NPI:1841819786
Name:HAAS, THOMAS III
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:HAAS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LAKE ST N # 55334
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2594
Mailing Address - Country:US
Mailing Address - Phone:651-464-2114
Mailing Address - Fax:651-464-2041
Practice Address - Street 1:107 LAKE ST N # 55334
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2594
Practice Address - Country:US
Practice Address - Phone:651-464-2114
Practice Address - Fax:651-464-2041
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist