Provider Demographics
NPI:1255054151
Name:THOMAS, FELICIA DENISE (RPH)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:DENISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6760
Mailing Address - Country:US
Mailing Address - Phone:903-452-2800
Mailing Address - Fax:
Practice Address - Street 1:119 W MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5340
Practice Address - Country:US
Practice Address - Phone:903-753-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist