Provider Demographics
NPI:1285039883
Name:THOMAS, JUSTIN JOHN (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOHN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHARTER ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1335
Mailing Address - Country:US
Mailing Address - Phone:806-236-1006
Mailing Address - Fax:
Practice Address - Street 1:429 BROOKLINE AVE.
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-232-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist