Provider Demographics
NPI:1154606259
Name:THOMAS, JUDY BUTLER (BPHARM)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:BUTLER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 SONOMA HWY APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-6527
Mailing Address - Country:US
Mailing Address - Phone:707-833-5176
Mailing Address - Fax:707-833-1315
Practice Address - Street 1:9080 BROOKS RD S
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7811
Practice Address - Country:US
Practice Address - Phone:707-837-2002
Practice Address - Fax:707-837-2005
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist