Provider Demographics
NPI:1952305328
Name:THOMAS, CHARLES CLIFFORD (R PH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CLIFFORD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 MALONE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2647
Mailing Address - Country:US
Mailing Address - Phone:334-279-3823
Mailing Address - Fax:
Practice Address - Street 1:3124 MALONE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2647
Practice Address - Country:US
Practice Address - Phone:334-279-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist