Provider Demographics
NPI:1336747757
Name:THOMASON, GREGORY ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:THOMASON
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 1:863 AMSTERDAM AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3403
Mailing Address - Country:US
Mailing Address - Phone:678-772-1728
Mailing Address - Fax:
Practice Address - Street 1:2452 MOROSGO WAY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3408
Practice Address - Country:US
Practice Address - Phone:404-946-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0129501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist