Provider Demographics
NPI:1760718597
Name:THOMAS, STANLEY R (RPH)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:R
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 1:1461 ROBERT B CULLUM BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75210-2404
Mailing Address - Country:US
Mailing Address - Phone:214-421-0750
Mailing Address - Fax:214-421-2043
Practice Address - Street 1:1461 ROBERT B CULLUM BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-2404
Practice Address - Country:US
Practice Address - Phone:214-421-0750
Practice Address - Fax:214-421-2043
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX034161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist