Provider Demographics
NPI:1811599939
Name:THOMAS, WALTER IRVING II (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:IRVING
Last Name:THOMAS
Suffix:II
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 1:5009 STEAGALL CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6067
Mailing Address - Country:US
Mailing Address - Phone:214-796-0041
Mailing Address - Fax:
Practice Address - Street 1:1900 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2346
Practice Address - Country:US
Practice Address - Phone:972-563-5767
Practice Address - Fax:972-524-6824
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist