Healthcare Provider Details

I. General information

NPI: 1972122307
Provider Name (Legal Business Name): ETHAN LYNN THOMAS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 HIGHWAY 100 STE 1231
NASHVILLE TN
37205-2821
US

IV. Provider business mailing address

1205 PARIS AVE APT 211
NASHVILLE TN
37212-5971
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-6963
  • Fax:
Mailing address:
  • Phone: 606-688-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number46854
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: