Provider Demographics
NPI:1710270970
Name:THOMAS, PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 5TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-9558
Mailing Address - Country:US
Mailing Address - Phone:304-523-5003
Mailing Address - Fax:304-523-2462
Practice Address - Street 1:4352 5TH STREET RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-9558
Practice Address - Country:US
Practice Address - Phone:304-523-5003
Practice Address - Fax:304-523-2462
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist