Provider Demographics
NPI:1508115569
Name:THOMAS, EDWARD RAGLAND IV (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RAGLAND
Last Name:THOMAS
Suffix:IV
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10227 BEACH DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467
Mailing Address - Country:US
Mailing Address - Phone:910-579-3200
Mailing Address - Fax:910-579-5381
Practice Address - Street 1:10227 BEACH DRIVE SW
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467
Practice Address - Country:US
Practice Address - Phone:910-579-3200
Practice Address - Fax:910-579-5381
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA202012497183500000X
NC14012183500000X
SC11364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist