Provider Demographics
NPI:1457798589
Name:THOMAS, JAMES R (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2541 S BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SISTER BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54234-9158
Mailing Address - Country:US
Mailing Address - Phone:920-854-9182
Mailing Address - Fax:920-854-9184
Practice Address - Street 1:2541 S BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-9158
Practice Address - Country:US
Practice Address - Phone:920-854-9182
Practice Address - Fax:920-854-9184
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11198-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist