MEDICARE: KATELYN THOMAS PHARM.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	183500000X	Pharmacist	PST.022156	LA

General Provider Information

NPI Number	:	1598283277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN THOMAS PHARM.D.

Provider Business Mailing Address
First Line	:	7913 ELLIOTT RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-0568
Country	:	US
Telephone Number	:	337-540-2430
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 COUNTRY CLUB RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5206
Country	:	US
Telephone Number	:	337-990-4902
Fax Number	:	337-990-4904

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

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	03/17/2018

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