Provider Demographics
NPI:1083182620
Name:THOMAS, ERICA DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DAWN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39900 205TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-3201
Mailing Address - Country:US
Mailing Address - Phone:217-370-2819
Mailing Address - Fax:
Practice Address - Street 1:825 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1372
Practice Address - Country:US
Practice Address - Phone:217-285-5515
Practice Address - Fax:217-285-1326
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist