MEDICARE: BRENT THOMAS PHARMD

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	RPH033836	GA

General Provider Information

NPI Number	:	1255053534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT THOMAS PHARMD

Provider Business Mailing Address
First Line	:	7300 GA HIGHWAY 21
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9205
Country	:	US
Telephone Number	:	912-964-1797
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 GA HIGHWAY 21
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9205
Country	:	US
Telephone Number	:	912-964-1797
Fax Number	:

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

Provider Enumeration Date	:	09/14/2022
Last Update Date	:	09/14/2022

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Directions to “ BRENT THOMAS PHARMD” Practice Location

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