MEDICARE: MR. THOMAS ENDICOTT RPH

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	6120	OR

General Provider Information

NPI Number	:	1477854909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ENDICOTT RPH

Provider Business Mailing Address
First Line	:	2740 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4604
Country	:	US
Telephone Number	:	541-273-3515
Fax Number	:	541-273-3518

Provider Business Practice Location Address
First Line	:	2740 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4604
Country	:	US
Telephone Number	:	541-273-3515
Fax Number	:	541-273-3518

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

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/15/2010

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