MEDICARE: MR. THOMAS ALLEN BABB R.PH.

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	27077	TX
2	183500000X	Pharmacist	013063	GA

General Provider Information

NPI Number	:	1881693539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ALLEN BABB R.PH.

Provider Business Mailing Address
First Line	:	1061 HARMON AVE
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5641
Country	:	US
Telephone Number	:	912-448-2410
Fax Number	:	912-435-6095

Provider Business Practice Location Address
First Line	:	1061 HARMON AVE
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5604
Country	:	US
Telephone Number	:	912-435-6796
Fax Number	:	912-435-6095

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/25/2011

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