Basic Information
| Provider Information | |||||||||
| NPI: | 1588791610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7161 CORSICA DR | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014813160 | ||||||||
| FaxNumber: | 9014481221 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PRIMACY PKWY | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014480255 | ||||||||
| FaxNumber: | 9014480404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 13278 | TN | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.