MEDICARE: DR. PHILLIP L THORNTON R.PH, PH.D.

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	1835P1200X	Pharmacotherapy Pharmacist	14350	AL
2	1835P1200X	Pharmacotherapy Pharmacist	11048	NC

General Provider Information

NPI Number	:	1538166426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP L THORNTON R.PH, PH.D.

Provider Business Mailing Address
First Line	:	4713 CARVING TREE DR
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-8807
Country	:	US
Telephone Number	:	704-499-5890
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 MATTHEWS MINT HILL RD
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-7593
Country	:	US
Telephone Number	:	704-910-2718
Fax Number	:	704-910-6441

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/21/2022

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