Healthcare Provider Details

I. General information

NPI: 1629148507
Provider Name (Legal Business Name): THOMAS E CUOMO CPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 EAGLES LANDING CIR W
CLEARWATER FL
33761-2800
US

IV. Provider business mailing address

3033 EAGLES LANDING CIR W
CLEARWATER FL
33761-2800
US

V. Phone/Fax

Practice location:
  • Phone: 239-851-1903
  • Fax:
Mailing address:
  • Phone: 239-851-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPU4286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: