MEDICARE: MS. MARY C THOMAS RPH, CGP, FSACP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202009151	VA

General Provider Information

NPI Number	:	1013999689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY C THOMAS RPH, CGP, FSACP

Provider Business Mailing Address
First Line	:	1771 TIMBER COVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-6083
Country	:	US
Telephone Number	:	336-817-8575
Fax Number	:

Provider Business Practice Location Address
First Line	:	3064 SALEM INDUSTRIAL DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-8854
Country	:	US
Telephone Number	:	336-831-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/06/2011

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