Provider Demographics
NPI:1164799334
Name:THOMAS, CLARENCE EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:EDWARD
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 1:527 THACKERAY TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2726
Mailing Address - Country:US
Mailing Address - Phone:440-446-1413
Mailing Address - Fax:440-446-1413
Practice Address - Street 1:1475 LANDER RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3358
Practice Address - Country:US
Practice Address - Phone:440-605-1695
Practice Address - Fax:440-605-1492
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03206634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist