Provider Demographics
NPI:1417121211
Name:THOMAS, RUSSELL LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 FOREST MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1632
Mailing Address - Country:US
Mailing Address - Phone:330-725-0535
Mailing Address - Fax:330-725-1459
Practice Address - Street 1:275 FOREST MEADOWS DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1632
Practice Address - Country:US
Practice Address - Phone:330-725-0535
Practice Address - Fax:330-725-1459
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-08883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist