Provider Demographics
NPI:1710451265
Name:THOMAS, MARCKEL LYNETTE
Entity Type:Individual
Prefix:
First Name:MARCKEL
Middle Name:LYNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GRAND RUE DE JOSH
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-4786
Mailing Address - Country:US
Mailing Address - Phone:985-991-6021
Mailing Address - Fax:
Practice Address - Street 1:185 GRAND RUE DE JOSH
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-4786
Practice Address - Country:US
Practice Address - Phone:985-991-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12390390200000X
LAPST.024012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program