Thomas Vanderholm, PHARMD
Individual provider Active NPI Pharmacist · Priest River, ID
NPI 1780170480 · NPPES record last updated Jul 5, 2018
Key facts
- NPI
- 1780170480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P8050 (ID)
- Practice address
- 5453 Highway 2
Priest River, ID 83856 - Phone
- (208) 448-1633
- NPI assigned
- Jul 5, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P8050 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deblaquiere Enterprises Inc | Past | Accepting new patients | |
| Deblaquiere Enterprises, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P8050 | ID | Yes |
Addresses
Primary practice location
5453 Highway 2
Priest River, ID 83856
Mailing address
5453 Hwy 2
Priest River, ID 83856
Phone (208) 448-1633
Other providers in Priest River, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.