Healthcare Provider Details

I. General information

NPI: 1942755061
Provider Name (Legal Business Name): JOHN BRIAN THOMAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN BRIAN THOMAS RPH

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 BIG TYLER RD.
CROSS LANES WV
25313
US

IV. Provider business mailing address

3625 WOODWARD DR.
CHARLESTON WV
25312
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-5178
  • Fax: 304-769-0393
Mailing address:
  • Phone: 304-549-7886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5637
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: