Provider Demographics
NPI:1962702761
Name:CRAGWALL, THOMAS O (DPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:O
Last Name:CRAGWALL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2123
Mailing Address - Country:US
Mailing Address - Phone:615-444-1245
Mailing Address - Fax:
Practice Address - Street 1:1500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3116
Practice Address - Country:US
Practice Address - Phone:615-547-1118
Practice Address - Fax:615-547-1594
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist