MEDICARE: BENJAMIN PAUL 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	03445631	OH

General Provider Information

NPI Number	:	1417811506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN PAUL THOMAS

Provider Business Mailing Address
First Line	:	2600 6TH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1702
Country	:	US
Telephone Number	:	815-687-4692
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E STATE ST
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4936
Country	:	US
Telephone Number	:	330-596-7970
Fax Number	:	330-596-6624

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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