Provider Demographics
NPI:1538469580
Name:THOMAS, MARY LO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 PLEASANT GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6117
Mailing Address - Country:US
Mailing Address - Phone:916-783-2128
Mailing Address - Fax:916-783-2134
Practice Address - Street 1:1080 PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6117
Practice Address - Country:US
Practice Address - Phone:916-783-2128
Practice Address - Fax:916-783-2134
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist