Healthcare Provider Details

I. General information

NPI: 1881682151
Provider Name (Legal Business Name): THOMAS ALLEN MAIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 PRAIRIE ST N
UNION SPRINGS AL
36089-1417
US

IV. Provider business mailing address

302 PRAIRIE ST N PO BOX 432
UNION SPRINGS AL
36089-1417
US

V. Phone/Fax

Practice location:
  • Phone: 334-738-2020
  • Fax: 334-738-8050
Mailing address:
  • Phone: 334-738-2020
  • Fax: 334-738-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13762
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: