MEDICARE: DR. SHANNON L 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	26020557A	IN

General Provider Information

NPI Number	:	1376744243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON L THOMAS

Provider Business Mailing Address
First Line	:	17205 BLACK CREEK CT
Second Line	:
City	:	HARLAN
State	:	IN
Zip	:	46743-9773
Country	:	US
Telephone Number	:	260-657-1382
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 EAST DUPONT RD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825
Country	:	US
Telephone Number	:	260-416-3140
Fax Number	:	260-416-3349

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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