Provider Demographics
NPI:1053911222
Name:SLOAN, THOMAS FRANKLIN
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:FRANKLIN
Last Name:SLOAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GARDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-6863
Mailing Address - Country:US
Mailing Address - Phone:662-687-0804
Mailing Address - Fax:
Practice Address - Street 1:3929 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0915
Practice Address - Country:US
Practice Address - Phone:662-840-5546
Practice Address - Fax:662-840-8379
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-08423183500000X
MO2000165337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist