Provider Demographics
NPI:1780003491
Name:THOMAS, ABISH
Entity Type:Individual
Prefix:
First Name:ABISH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 W MAIN ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4119
Mailing Address - Country:US
Mailing Address - Phone:863-419-7777
Mailing Address - Fax:863-419-7772
Practice Address - Street 1:740 W MAIN ST UNIT 5
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4119
Practice Address - Country:US
Practice Address - Phone:863-419-7777
Practice Address - Fax:863-419-7772
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2022-05-13
Deactivation Date:2018-09-25
Deactivation Code:
Reactivation Date:2018-10-03
Provider Licenses
StateLicense IDTaxonomies
FLPS39557183500000X
NY057921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist