Provider Demographics
NPI:1467746842
Name:THOMAS, JAMES MAXWELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MAXWELL
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 1:815 W STATE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2101
Mailing Address - Country:US
Mailing Address - Phone:801-922-4256
Mailing Address - Fax:801-922-4259
Practice Address - Street 1:815 W STATE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2101
Practice Address - Country:US
Practice Address - Phone:801-922-4256
Practice Address - Fax:801-922-4259
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT271126-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist