Healthcare Provider Details

I. General information

NPI: 1932237112
Provider Name (Legal Business Name): THOMAS E NELSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 AVENUE L
FORT MADISON IA
52627-3933
US

IV. Provider business mailing address

2402 HILLCREST RD
DONNELLSON IA
52625-9160
US

V. Phone/Fax

Practice location:
  • Phone: 319-372-2300
  • Fax:
Mailing address:
  • Phone: 319-835-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18793
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: