Provider Demographics
NPI:1568860468
Name:THOMAS, JILLIAN BLAIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:BLAIR
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:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-0558
Mailing Address - Country:US
Mailing Address - Phone:251-675-3228
Mailing Address - Fax:
Practice Address - Street 1:5567 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:AL
Practice Address - Zip Code:36572-2108
Practice Address - Country:US
Practice Address - Phone:257-675-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist