MEDICARE: MR. THOMAS E NELSON 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	18793	IA

General Provider Information

NPI Number	:	1932237112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS E NELSON RPH

Provider Business Mailing Address
First Line	:	2402 HILLCREST RD
Second Line	:
City	:	DONNELLSON
State	:	IA
Zip	:	52625-9160
Country	:	US
Telephone Number	:	319-835-9065
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 AVENUE L
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-3933
Country	:	US
Telephone Number	:	319-372-2300
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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