Provider Demographics
NPI:1033491550
Name:THORNTON, PHYLLIS
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 FIELDSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-4336
Mailing Address - Country:US
Mailing Address - Phone:615-591-5828
Mailing Address - Fax:
Practice Address - Street 1:2045 FIELDSTONE PKWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-4336
Practice Address - Country:US
Practice Address - Phone:615-591-5828
Practice Address - Fax:615-327-3942
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist