Provider Demographics
NPI:1487217600
Name:THOMAS, JOHN EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
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 1:153 MOSS ROCK CT
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-7600
Mailing Address - Country:US
Mailing Address - Phone:719-687-4308
Mailing Address - Fax:719-687-6895
Practice Address - Street 1:19600 E US HIGHWAY 24 STE 100
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8766
Practice Address - Country:US
Practice Address - Phone:719-687-4308
Practice Address - Fax:719-687-6895
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0018273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist