Provider Demographics
NPI:1487942371
Name:THOMAS, NATASHA (PHARMD)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
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 1:10170 GREEN LEVEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8132
Mailing Address - Country:US
Mailing Address - Phone:919-467-0211
Mailing Address - Fax:
Practice Address - Street 1:10170 GREEN LEVEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8132
Practice Address - Country:US
Practice Address - Phone:919-467-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920248Medicaid
NC0920248Medicaid