Provider Demographics
NPI:1619204252
Name:THOMAS, TYRICE A
Entity Type:Individual
Prefix:
First Name:TYRICE
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TYRICE
Other - Middle Name:A
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:734 E PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4006
Mailing Address - Country:US
Mailing Address - Phone:972-274-2178
Mailing Address - Fax:972-274-1317
Practice Address - Street 1:734 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4006
Practice Address - Country:US
Practice Address - Phone:972-274-2178
Practice Address - Fax:972-274-1317
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist