Healthcare Provider Details

I. General information

NPI: 1801705298
Provider Name (Legal Business Name): DR. TITUS THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7494 US HIGHWAY 11
POTSDAM NY
13676-3577
US

IV. Provider business mailing address

7494 US HIGHWAY 11
POTSDAM NY
13676-3577
US

V. Phone/Fax

Practice location:
  • Phone: 315-268-6917
  • Fax: 315-268-6919
Mailing address:
  • Phone: 315-268-6917
  • Fax: 315-268-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: