Provider Demographics
NPI:1497355630
Name:THOMAS, GEORGE CARROLL III
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:CARROLL
Last Name:THOMAS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 HANOVER LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6655
Mailing Address - Country:US
Mailing Address - Phone:405-808-6933
Mailing Address - Fax:
Practice Address - Street 1:2000 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6506
Practice Address - Country:US
Practice Address - Phone:405-752-2888
Practice Address - Fax:405-752-2606
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist