MEDICARE: MR. STANLEY R 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	034161	TX

General Provider Information

NPI Number	:	1760718597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STANLEY R THOMAS R.PH

Provider Business Mailing Address
First Line	:	1461 ROBERT B CULLUM BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-2404
Country	:	US
Telephone Number	:	214-421-0750
Fax Number	:	214-421-2043

Provider Business Practice Location Address
First Line	:	1461 ROBERT B CULLUM BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-2404
Country	:	US
Telephone Number	:	214-421-0750
Fax Number	:	214-421-2043

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

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	10/29/2009

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