Provider Demographics
NPI:1821200767
Name:THOMAS, JAMES BRADLEY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRADLEY
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 1:9506 HORN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1522
Mailing Address - Country:US
Mailing Address - Phone:410-340-3179
Mailing Address - Fax:410-668-6626
Practice Address - Street 1:1955 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2745
Practice Address - Country:US
Practice Address - Phone:410-665-5120
Practice Address - Fax:410-668-6626
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09861OtherPHARMACIST LICENSE