Provider Demographics
NPI:1972122307
Name:THOMAS, ETHAN LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 PARIS AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5971
Mailing Address - Country:US
Mailing Address - Phone:606-688-9933
Mailing Address - Fax:
Practice Address - Street 1:6002 HIGHWAY 100 STE 1231
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2821
Practice Address - Country:US
Practice Address - Phone:615-936-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN468541835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology