Provider Demographics
NPI:1700509189
Name:THOMAS, LEVIN MANUEL (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LEVIN
Middle Name:MANUEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1980
Mailing Address - Country:US
Mailing Address - Phone:845-450-4003
Mailing Address - Fax:
Practice Address - Street 1:143 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1980
Practice Address - Country:US
Practice Address - Phone:845-450-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist