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General NPI Number Information
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NPI Number | 1942755061
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Entity Type | Individual
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Provider Name | JOHN BRIAN THOMAS RPH
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Gender | Male
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 5450 BIG TYLER RD.
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City | CROSS LANES
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State | WV
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Zip | 25313
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Country | US
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Telephone | 304-776-5178
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Fax | 304-769-0393
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Provider Business Mailing Address
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Address Line | 3625 WOODWARD DR.
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City | CHARLESTON
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State | WV
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Zip | 25312
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Country | US
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Telephone | 304-549-7886
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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 | 5637
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License Number State | WV
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