Healthcare Provider Details

I. General information

NPI: 1851987770
Provider Name (Legal Business Name): NANCY O'QUINN THOMAS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W 1ST ST
GROVETON TX
75845-4175
US

IV. Provider business mailing address

PO BOX 1
APPLE SPRINGS TX
75926-0001
US

V. Phone/Fax

Practice location:
  • Phone: 936-642-1174
  • Fax: 936-642-0011
Mailing address:
  • Phone: 936-525-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: