Provider Demographics
NPI:1942755061
Name:THOMAS, JOHN BRIAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRIAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:BRIAN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3625 WOODWARD DR.
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312
Mailing Address - Country:US
Mailing Address - Phone:304-549-7886
Mailing Address - Fax:
Practice Address - Street 1:5450 BIG TYLER RD.
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313
Practice Address - Country:US
Practice Address - Phone:304-776-5178
Practice Address - Fax:304-769-0393
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist