Provider Demographics
NPI:1073905394
Name:THOMAS, SANTHOSH
Entity Type:Individual
Prefix:MR
First Name:SANTHOSH
Middle Name:
Last Name:THOMAS
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 1:2704 DURANT TRAILS BLVD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-6449
Mailing Address - Country:US
Mailing Address - Phone:813-689-3830
Mailing Address - Fax:
Practice Address - Street 1:2535 E STATE ROAD 60
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3830
Practice Address - Country:US
Practice Address - Phone:813-657-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist