Provider Demographics
NPI:1235419961
Name:THOMAS, MICHELLE E (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
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 1:4561 N PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-1331
Mailing Address - Country:US
Mailing Address - Phone:918-425-5716
Mailing Address - Fax:918-425-5965
Practice Address - Street 1:4561 N PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1331
Practice Address - Country:US
Practice Address - Phone:918-425-5716
Practice Address - Fax:918-425-5965
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist