Provider Demographics
NPI:1013999689
Name:THOMAS, MARY C (RPH, CGP, FSACP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPH, CGP, FSACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 TIMBER COVE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6083
Mailing Address - Country:US
Mailing Address - Phone:336-817-8575
Mailing Address - Fax:
Practice Address - Street 1:3064 SALEM INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-8854
Practice Address - Country:US
Practice Address - Phone:336-831-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist