Provider Demographics
NPI:1720298250
Name:THOMAS, AMY M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17675 SW WAKEM ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4400
Mailing Address - Country:US
Mailing Address - Phone:503-649-4199
Mailing Address - Fax:
Practice Address - Street 1:888 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5975
Practice Address - Country:US
Practice Address - Phone:503-681-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist