MEDICARE: MRS. CHERYL ANNE THOMAS R.PH.

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	26014517	IN
2	183500000X	Pharmacist	PS51154	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS51154	OTHER	FL	STATE

General Provider Information

NPI Number	:	1477693646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL ANNE THOMAS R.PH.

Provider Business Mailing Address
First Line	:	3009 BEACH PKWY W
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6042
Country	:	US
Telephone Number	:	812-322-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 SANTA BARBARA BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4485
Country	:	US
Telephone Number	:	239-458-8570
Fax Number	:	239-829-8161

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	12/06/2014

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