Provider Demographics
NPI:1477693646
Name:THOMAS, CHERYL ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANNE
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 1:3009 BEACH PKWY W
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6042
Mailing Address - Country:US
Mailing Address - Phone:812-322-4143
Mailing Address - Fax:
Practice Address - Street 1:2430 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4485
Practice Address - Country:US
Practice Address - Phone:239-458-8570
Practice Address - Fax:239-829-8161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014517183500000X
FLPS51154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS51154OtherSTATE