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NPI Code Detail

MEDICARE: THOMAS HENRY FUNK RPH

MEDICARE: THOMAS HENRY FUNK 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
1183500000XPharmacist051033961IL

General Provider Information

NPI Number : 1639479058
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS HENRY FUNK RPH
Provider Business Mailing Address
First Line : 2501 VIRGINIA AVE
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-5588
Country : US
Telephone Number : 630-244-3131
Fax Number :
Provider Business Practice Location Address
First Line : 2501 VIRGINIA AVE
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-5588
Country : US
Telephone Number : 630-244-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2010
Last Update Date : 12/23/2022

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Directions to “ THOMAS HENRY FUNK RPH” Practice Location

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