Provider Demographics
NPI:1780975219
Name:THOMAS, MICHAEL NELSON (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NELSON
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 TOWNE CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3020
Mailing Address - Country:US
Mailing Address - Phone:443-837-3541
Mailing Address - Fax:443-837-3551
Practice Address - Street 1:1911 TOWNE CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3020
Practice Address - Country:US
Practice Address - Phone:443-837-3541
Practice Address - Fax:443-837-3551
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist