Provider Demographics
NPI:1154658441
Name:THOMAS, AVERETT VINCENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:AVERETT
Middle Name:VINCENT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3001
Mailing Address - Country:US
Mailing Address - Phone:336-540-1344
Mailing Address - Fax:336-540-1843
Practice Address - Street 1:3703 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3001
Practice Address - Country:US
Practice Address - Phone:336-540-1344
Practice Address - Fax:336-540-1843
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist