Provider Demographics
NPI:1467461160
Name:THOMAS, KEVIN A (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
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 1:505 W 400 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1950
Mailing Address - Country:US
Mailing Address - Phone:801-714-3511
Mailing Address - Fax:801-714-3516
Practice Address - Street 1:505 W 400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1950
Practice Address - Country:US
Practice Address - Phone:801-714-3511
Practice Address - Fax:801-714-3516
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT148370-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist