Provider Demographics
NPI:1285914754
Name:THOMAS, ALVIN L (PHARM D)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MONTANO RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5746
Mailing Address - Country:US
Mailing Address - Phone:505-922-4997
Mailing Address - Fax:505-922-6324
Practice Address - Street 1:4201 MONTANO RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5746
Practice Address - Country:US
Practice Address - Phone:505-922-4997
Practice Address - Fax:505-922-6324
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist