Provider Demographics
NPI:1548861412
Name:DUFF, THOMAS (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DUFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 CLEARBROOK VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-6606
Mailing Address - Country:US
Mailing Address - Phone:540-772-7193
Mailing Address - Fax:540-776-3116
Practice Address - Street 1:5350 CLEARBROOK VILLAGE LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-6606
Practice Address - Country:US
Practice Address - Phone:540-772-7193
Practice Address - Fax:540-776-3116
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist