Provider Demographics
NPI:1295181733
Name:THOMAS, KECIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KECIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 S STONY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3914
Mailing Address - Country:US
Mailing Address - Phone:773-288-7000
Mailing Address - Fax:773-288-7009
Practice Address - Street 1:7530 S STONY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3914
Practice Address - Country:US
Practice Address - Phone:773-288-7000
Practice Address - Fax:773-288-7009
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist