Provider Demographics
NPI:1700450798
Name:THOMAS, STEPHANIE RENEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RENEA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10741 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2403
Mailing Address - Country:US
Mailing Address - Phone:314-521-2230
Mailing Address - Fax:
Practice Address - Street 1:10741 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2403
Practice Address - Country:US
Practice Address - Phone:314-521-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.303663183500000X
ARPD10108183500000X
MO2008017698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist