Provider Demographics
NPI:1851512339
Name:THOMAS, CHRISTINE MARGARET (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARGARET
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SUNRISE DR.
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837
Mailing Address - Country:US
Mailing Address - Phone:517-627-1612
Mailing Address - Fax:616-374-0921
Practice Address - Street 1:838 FOUTH AVE
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849
Practice Address - Country:US
Practice Address - Phone:616-374-3190
Practice Address - Fax:616-374-0921
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist