Healthcare Provider Details

I. General information

NPI: 1508920430
Provider Name (Legal Business Name): THOMAS ALBERT SAXBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 STATE ROUTE 37
AKWESASNE NY
13655-3109
US

IV. Provider business mailing address

412 STATE ROUTE 37
AKWESASNE NY
13655-3109
US

V. Phone/Fax

Practice location:
  • Phone: 518-358-3141
  • Fax: 518-358-2797
Mailing address:
  • Phone: 518-358-3141
  • Fax: 518-358-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: