Provider Demographics
NPI:1730783937
Name:THOMAS, LYSHONDA TERESA (PHARMD)
Entity type:Individual
Prefix:
First Name:LYSHONDA
Middle Name:TERESA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LYSHONDA
Other - Middle Name:TERESA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2305 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1329
Mailing Address - Country:US
Mailing Address - Phone:678-423-1043
Mailing Address - Fax:678-423-1043
Practice Address - Street 1:2305 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1329
Practice Address - Country:US
Practice Address - Phone:678-423-1043
Practice Address - Fax:678-423-1043
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0202421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist