Healthcare Provider Details

I. General information

NPI: 1932705522
Provider Name (Legal Business Name): JENNIFER THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E HUNDRED RD
CHESTER VA
23836-2613
US

IV. Provider business mailing address

11631 BEACH RD
CHESTERFIELD VA
23838-3520
US

V. Phone/Fax

Practice location:
  • Phone: 804-530-1172
  • Fax:
Mailing address:
  • Phone: 804-387-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209298
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: