Provider Demographics
NPI:1518187830
Name:BARNES, THOMAS SHANE (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:SHANE
Last Name:BARNES
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 1:141 HUNTERS FIELD WAY
Mailing Address - Street 2:
Mailing Address - City:KINGS MTN
Mailing Address - State:NC
Mailing Address - Zip Code:28086
Mailing Address - Country:US
Mailing Address - Phone:704-259-5427
Mailing Address - Fax:704-864-7466
Practice Address - Street 1:701 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3830
Practice Address - Country:US
Practice Address - Phone:704-867-9611
Practice Address - Fax:704-864-7466
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist