Provider Demographics
NPI:1184978058
Name:THOMS, MARK DANA (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANA
Last Name:THOMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1323
Mailing Address - Country:US
Mailing Address - Phone:231-290-0819
Mailing Address - Fax:
Practice Address - Street 1:1021 DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1323
Practice Address - Country:US
Practice Address - Phone:231-290-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist