Provider Demographics
NPI:1699044263
Name:THOMAS, KATHLEEN P (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22449 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2016
Mailing Address - Country:US
Mailing Address - Phone:941-625-4346
Mailing Address - Fax:941-625-1287
Practice Address - Street 1:22449 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2016
Practice Address - Country:US
Practice Address - Phone:941-625-4346
Practice Address - Fax:941-625-1287
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist