Provider Demographics
NPI:1073658316
Name:JOHN HENRY THOMASON
Entity Type:Organization
Organization Name:JOHN HENRY THOMASON
Other - Org Name:JOHNS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-396-1636
Mailing Address - Street 1:201 E ROGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-1251
Mailing Address - Country:US
Mailing Address - Phone:918-396-1636
Mailing Address - Fax:918-396-1637
Practice Address - Street 1:201 E ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1251
Practice Address - Country:US
Practice Address - Phone:918-396-1636
Practice Address - Fax:918-396-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK2-943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3700487OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OK100233060AMedicaid