Provider Demographics
NPI:1346845641
Name:THORNSBERRY, JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:THORNSBERRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 LEESVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7604
Mailing Address - Country:US
Mailing Address - Phone:984-302-3001
Mailing Address - Fax:
Practice Address - Street 1:9305 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-2761
Practice Address - Country:US
Practice Address - Phone:903-933-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13660183500000X
NC29580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist