Provider Demographics
NPI:1376757302
Name:THOMAS, GWEN LOUISE (RPH)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:LOUISE
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 1:35 BROADWAY
Mailing Address - Street 2:PO BOX 517
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-0517
Mailing Address - Country:US
Mailing Address - Phone:570-325-8018
Mailing Address - Fax:
Practice Address - Street 1:590 COAL STREET
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1339
Practice Address - Country:US
Practice Address - Phone:610-377-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP415689L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist