Provider Demographics
NPI:1194500868
Name:THOMAS, RENU ELIZABETH
Entity type:Individual
Prefix:
First Name:RENU
Middle Name:ELIZABETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 WOODBRUSH WAY
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9211
Mailing Address - Country:US
Mailing Address - Phone:972-999-3824
Mailing Address - Fax:
Practice Address - Street 1:1000 EASTON RD STE 200
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2981
Practice Address - Country:US
Practice Address - Phone:215-887-8523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI016308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist