Provider Demographics
NPI:1396964334
Name:THOMASSON, REBECCA JOAN (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOAN
Last Name:THOMASSON
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 1:228 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-5720
Mailing Address - Country:US
Mailing Address - Phone:850-236-4342
Mailing Address - Fax:
Practice Address - Street 1:3157 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1828
Practice Address - Country:US
Practice Address - Phone:850-747-0777
Practice Address - Fax:850-747-9010
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist