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General NPI Number Information
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NPI Number | 1992762561
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Entity Type | Individual
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Provider Name | MR. THOMAS DONALD PERCIVAL
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7506 PACIFIC AVE
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City | STOCKTON
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State | CA
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Zip | 95207-1929
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Country | US
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Telephone | 209-951-1051
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Fax | 209-951-8572
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Provider Business Mailing Address
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Address Line | 11351 N MICKE GROVE RD
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City | LODI
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State | CA
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Zip | 95240-9405
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Country | US
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Telephone | 209-367-5491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 32340
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License Number State | CA
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