Provider Demographics
NPI:1689953242
Name:THOMAS, MCHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MCHELLE
Middle Name:
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 1:4710 DUNCASTLE RD APT 1C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1644
Mailing Address - Country:US
Mailing Address - Phone:219-789-4024
Mailing Address - Fax:
Practice Address - Street 1:3100 LEGION RD
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1633
Practice Address - Country:US
Practice Address - Phone:910-424-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist