Provider Demographics
NPI:1720682198
Name:BANES, THOMAS MORGAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MORGAN
Last Name:BANES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6724 S LEWIS AVE UNIT 1302
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4040
Mailing Address - Country:US
Mailing Address - Phone:918-637-0140
Mailing Address - Fax:
Practice Address - Street 1:11223 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-1708
Practice Address - Country:US
Practice Address - Phone:918-622-3563
Practice Address - Fax:918-622-3692
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist