Provider Demographics
NPI:1134473234
Name:THOMAS PHARMACY GARDINER CENTER, LLC
Entity Type:Organization
Organization Name:THOMAS PHARMACY GARDINER CENTER, LLC
Other - Org Name:THOMAS PHARMACY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-428-5977
Mailing Address - Street 1:PO BOX 4111
Mailing Address - Street 2:170 BEACON STREET
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-4111
Mailing Address - Country:US
Mailing Address - Phone:601-428-5977
Mailing Address - Fax:601-518-5306
Practice Address - Street 1:733 LIMBERT ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-5246
Practice Address - Country:US
Practice Address - Phone:601-342-2273
Practice Address - Fax:601-651-6125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS PHARMACY GARDINER CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-29
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11692/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies