Provider Demographics
NPI:1497060750
Name:THOMAS, SHIRLEY DIANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:DIANN
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 1:500 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4722
Mailing Address - Country:US
Mailing Address - Phone:214-946-1700
Mailing Address - Fax:214-946-8300
Practice Address - Street 1:500 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4722
Practice Address - Country:US
Practice Address - Phone:214-946-1700
Practice Address - Fax:214-946-8300
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist