Provider Demographics
NPI:1851836134
Name:THOMAS, BRIAN MARK (DO, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MARK
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3656
Mailing Address - Country:US
Mailing Address - Phone:973-954-0511
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI037114001835P1200X
NJ390200000X
PAOT022383208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program