Healthcare Provider Details

I. General information

NPI: 1982907002
Provider Name (Legal Business Name): BLAKE E THOMAS PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2010
Last Update Date: 12/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 CENTER POINT RD
PINSON AL
35126-4209
US

IV. Provider business mailing address

4701 CENTER POINT RD
PINSON AL
35126-4209
US

V. Phone/Fax

Practice location:
  • Phone: 205-680-3969
  • Fax: 205-680-0935
Mailing address:
  • Phone: 205-680-3969
  • Fax: 205-680-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15835
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: