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NPI Code Detail

MEDICARE: BIANCA THOMAS RPH

MEDICARE: BIANCA THOMAS RPH
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
1183500000XPharmacistPS64418FL

General Provider Information

NPI Number : 1164158242
Entity Type Code : Individual
Provider Name (Legal Business Name) : BIANCA THOMAS RPH
Provider Business Mailing Address
First Line : 120 MARKETSIDE AVE
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-0574
Country : US
Telephone Number : 904-825-1913
Fax Number :
Provider Business Practice Location Address
First Line : 120 MARKETSIDE AVE
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-0574
Country : US
Telephone Number : 904-825-1913
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2022
Last Update Date : 07/29/2022

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