Healthcare Provider Details

I. General information

NPI: 1952375701
Provider Name (Legal Business Name): THOMAS H HOFER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S MAIN ST
NORTH ENGLISH IA
52316
US

IV. Provider business mailing address

5463 KURTZ STRASZE SW
KALONA IA
52247
US

V. Phone/Fax

Practice location:
  • Phone: 319-664-3115
  • Fax:
Mailing address:
  • Phone: 319-656-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12894
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: