Healthcare Provider Details

I. General information

NPI: 1306834254
Provider Name (Legal Business Name): THOMAS EDWARD WHISTON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST
MOUNT GILEAD OH
43338-1445
US

IV. Provider business mailing address

187 IBERIA ST
MOUNT GILEAD OH
43338-1281
US

V. Phone/Fax

Practice location:
  • Phone: 419-946-6492
  • Fax: 419-947-1215
Mailing address:
  • Phone: 419-947-3930
  • Fax: 419-947-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03314377
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: