Provider Demographics
NPI:1417321183
Name:THOMAS, KAVITHA (BPHARM)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4407
Mailing Address - Country:US
Mailing Address - Phone:952-445-1727
Mailing Address - Fax:952-253-1727
Practice Address - Street 1:1685 17TH AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4407
Practice Address - Country:US
Practice Address - Phone:952-445-1927
Practice Address - Fax:952-253-1727
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN117230OtherPHARMACIST LICENSE