Provider Demographics
NPI:1992788913
Name:WILMORE, TOMMY STEVEN (DPH)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:STEVEN
Last Name:WILMORE
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 1:5 HALIBURTON LN
Mailing Address - Street 2:
Mailing Address - City:RIDDLETON
Mailing Address - State:TN
Mailing Address - Zip Code:37151-2221
Mailing Address - Country:US
Mailing Address - Phone:615-735-0810
Mailing Address - Fax:615-735-1077
Practice Address - Street 1:1210 MAIN ST N
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030
Practice Address - Country:US
Practice Address - Phone:615-735-2060
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist