Provider Demographics
NPI:1124309166
Name:THOMAS, GAIL EILEEN (RPH)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:EILEEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 VALLEY CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2331
Mailing Address - Country:US
Mailing Address - Phone:858-793-4667
Mailing Address - Fax:858-793-4431
Practice Address - Street 1:3850 VALLEY CENTRE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2331
Practice Address - Country:US
Practice Address - Phone:858-793-4667
Practice Address - Fax:858-793-4431
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA430750Medicaid