MEDICARE: MR. THOMAS J MARKUS JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PP410064L	PA

General Provider Information

NPI Number	:	1134410665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS J MARKUS JR.

Provider Business Mailing Address
First Line	:	PO BOX 388
Second Line	:	4 TROLLEY ST
City	:	CUMBOLA
State	:	PA
Zip	:	17930-0388
Country	:	US
Telephone Number	:	570-277-0287
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 S MAIN ST
Second Line	:
City	:	SHENANDOAH
State	:	PA
Zip	:	17976-2332
Country	:	US
Telephone Number	:	570-462-1924
Fax Number	:	570-462-1760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	05/02/2011

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