Provider Demographics
NPI:1366299364
Name:THOMAS, TILA JENIQUE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TILA
Middle Name:JENIQUE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 COMMUNITY DR APT 402
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-6715
Mailing Address - Country:US
Mailing Address - Phone:302-584-5311
Mailing Address - Fax:
Practice Address - Street 1:2751 HEARTLAND DR
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2731
Practice Address - Country:US
Practice Address - Phone:319-545-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist