Basic Information
| Provider Information | |||||||||
| NPI: | 1003152877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD, RPH | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 OLD REDWOOD HWY | ||||||||
| Address2: | |||||||||
| City: | COTATI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949315106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077956014 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7800 OLD REDWOOD HWY | ||||||||
| Address2: | |||||||||
| City: | COTATI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949315106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077956014 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2012 | ||||||||
| LastUpdateDate: | 12/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH68230 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.