Healthcare Provider Details

I. General information

NPI: 1245706092
Provider Name (Legal Business Name): THOMAS CLOSSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TWIN SPRINGS RD
HALETHORPE MD
21227-3553
US

IV. Provider business mailing address

4321 BLACK ROCK RD
HAMPSTEAD MD
21074-2620
US

V. Phone/Fax

Practice location:
  • Phone: 443-996-0406
  • Fax:
Mailing address:
  • Phone: 443-996-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number14131
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: