Provider Demographics
NPI:1538250378
Name:THOMAS, J RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:J
Middle Name:RICHARD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 MISSION 66
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-2753
Mailing Address - Country:US
Mailing Address - Phone:601-638-5521
Mailing Address - Fax:601-638-5521
Practice Address - Street 1:1017 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2753
Practice Address - Country:US
Practice Address - Phone:601-638-5521
Practice Address - Fax:601-638-5522
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist