MEDICARE: JIMMY 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	0531561	NY
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0531561	NY

General Provider Information

NPI Number	:	1679895064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY THOMAS

Provider Business Mailing Address
First Line	:	557 S PASCACK RD
Second Line	:
City	:	CHESTNUT RDG
State	:	NY
Zip	:	10977-7113
Country	:	US
Telephone Number	:	914-310-5780
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 S PASCACK RD
Second Line	:
City	:	CHESTNUT RDG
State	:	NY
Zip	:	10977-7113
Country	:	US
Telephone Number	:	914-310-5780
Fax Number	:

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	02/25/2010

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Directions to “ JIMMY THOMAS ” Practice Location

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