=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104226364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHELLE JOELLE THOMAS PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2014
-----------------------------------------------------
Last Update Date | 08/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2710 N UNIVERSITY DR
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-431-9811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2240 NW 47TH TER
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33313-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-729-9533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS52495
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------