Healthcare Provider Details

I. General information

NPI: 1679460885
Provider Name (Legal Business Name): JAMIE K. THOMAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST STE 9115
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

1520 W HARRISON ST STE 9115
CHICAGO IL
60607-3106
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-2363
  • Fax:
Mailing address:
  • Phone: 312-563-2363
  • Fax: 312-563-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number051301368
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051301368
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: