Provider Demographics
NPI:1508091299
Name:THOMASON, SHELTON W JR (R PH)
Entity Type:Individual
Prefix:MR
First Name:SHELTON
Middle Name:W
Last Name:THOMASON
Suffix:JR
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0096
Mailing Address - Country:US
Mailing Address - Phone:336-246-9111
Mailing Address - Fax:336-246-3656
Practice Address - Street 1:749 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9280
Practice Address - Country:US
Practice Address - Phone:336-246-9111
Practice Address - Fax:336-246-3656
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist