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General NPI Number Information
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NPI Number | 1376744243
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Entity Type | Individual
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Provider Name | DR. SHANNON L THOMAS
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2520 EAST DUPONT RD.
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City | FORT WAYNE
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State | IN
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Zip | 46825
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Country | US
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Telephone | 260-416-3140
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Fax | 260-416-3349
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Provider Business Mailing Address
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Address Line | 17205 BLACK CREEK CT
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City | HARLAN
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State | IN
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Zip | 46743-9773
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Country | US
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Telephone | 260-657-1382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26020557A
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License Number State | IN
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