Provider Demographics
NPI:1043590680
Name:THOMAS, MICHAEL JON (PHARM D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JON
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9554 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1892
Mailing Address - Country:US
Mailing Address - Phone:815-806-0438
Mailing Address - Fax:815-806-9154
Practice Address - Street 1:9554 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1892
Practice Address - Country:US
Practice Address - Phone:815-806-0438
Practice Address - Fax:815-806-9154
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist