Provider Demographics
NPI:1407031818
Name:THOMAS, JACQUELINE RUDY (RPH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RUDY
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 1:4751 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3315
Mailing Address - Country:US
Mailing Address - Phone:315-476-2141
Mailing Address - Fax:315-475-8632
Practice Address - Street 1:4751 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3315
Practice Address - Country:US
Practice Address - Phone:315-476-2141
Practice Address - Fax:315-475-8632
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist