MEDICARE: NICK THOMAS

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	5127	ND

General Provider Information

NPI Number	:	1316147127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK THOMAS

Provider Business Mailing Address
First Line	:	310 SHADY LN
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-3828
Country	:	US
Telephone Number	:	701-663-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 NORTH RIVER RD
Second Line	:
City	:	FT YATES
State	:	ND
Zip	:	58538
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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Directions to “ NICK THOMAS ” Practice Location

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