Basic Information
Provider Information
NPI: 1871983809
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMAS
FirstName: JULIE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 680 OLD GREENVILLE HWY
Address2:  
City: CLEMSON
State: SC
PostalCode: 296311225
CountryCode: US
TelephoneNumber: 8647226055
FaxNumber: 8647226052
Practice Location
Address1: 680 OLD GREENVILLE HWY
Address2:  
City: CLEMSON
State: SC
PostalCode: 296311225
CountryCode: US
TelephoneNumber: 8647226055
FaxNumber: 8647226052
Other Information
ProviderEnumerationDate: 01/29/2015
LastUpdateDate: 01/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X12660SCY Pharmacy Service ProvidersPharmacist 

No ID Information.


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