Healthcare Provider Details

I. General information

NPI: 1568860468
Provider Name (Legal Business Name): JILLIAN BLAIR THOMAS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5567 HIGHWAY 43
SATSUMA AL
36572-2108
US

IV. Provider business mailing address

PO BOX 558
SATSUMA AL
36572-0558
US

V. Phone/Fax

Practice location:
  • Phone: 257-675-3228
  • Fax:
Mailing address:
  • Phone: 251-675-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17472
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: