Provider Demographics
NPI:1962747733
Name:FOLCK, THOMAS D (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:FOLCK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 STIRLING FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4206
Mailing Address - Country:US
Mailing Address - Phone:941-360-5111
Mailing Address - Fax:
Practice Address - Street 1:8300 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-6312
Practice Address - Country:US
Practice Address - Phone:941-378-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027013OtherPHARMACIST