Provider Demographics
NPI:1245517739
Name:THOMAS, SAMUEL JR
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 STONEMONT DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3501
Mailing Address - Country:US
Mailing Address - Phone:954-495-0345
Mailing Address - Fax:
Practice Address - Street 1:8450 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2334
Practice Address - Country:US
Practice Address - Phone:305-221-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist