Healthcare Provider Details

I. General information

NPI: 1992099642
Provider Name (Legal Business Name): THOMAS HERRICK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 GEORGE W LILES PKWY NW
CONCORD NC
28027-2406
US

IV. Provider business mailing address

358 GEORGE W LILES PKWY NW
CONCORD NC
28027-2406
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-2534
  • Fax: 704-786-2584
Mailing address:
  • Phone: 704-786-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15289
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15289
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: