Provider Demographics
NPI:1952317729
Name:THOMAS, JOHN PARKS (PD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PARKS
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MCRAE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450-2124
Mailing Address - Country:US
Mailing Address - Phone:910-646-4636
Mailing Address - Fax:
Practice Address - Street 1:27449 ANDREW JACKSON HWY E
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-8822
Practice Address - Country:US
Practice Address - Phone:910-655-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist