Provider Demographics
NPI:1831643733
Name:THEBE, NOMPUMELELO
Entity Type:Individual
Prefix:
First Name:NOMPUMELELO
Middle Name:
Last Name:THEBE
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 1:12529 MEADOW LANDING DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0658
Mailing Address - Country:US
Mailing Address - Phone:469-432-3458
Mailing Address - Fax:
Practice Address - Street 1:120 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2331
Practice Address - Country:US
Practice Address - Phone:972-633-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0957932OtherCVS EMPLOYEE