Healthcare Provider Details

I. General information

NPI: 1942525142
Provider Name (Legal Business Name): MICHELLE ELKINS THOMASON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HIGHWAY 77
SOUTHSIDE AL
35907-0405
US

IV. Provider business mailing address

1250 HIGHWAY 77
SOUTHSIDE AL
35907-0405
US

V. Phone/Fax

Practice location:
  • Phone: 256-413-4473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14773
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: