Provider Demographics
NPI:1346559341
Name:THAMES, BILLY G (RPH)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:G
Last Name:THAMES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 COLLEGE AVE E
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-3511
Mailing Address - Country:US
Mailing Address - Phone:601-928-3215
Mailing Address - Fax:601-928-6072
Practice Address - Street 1:116 SECOND ST S
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2758
Practice Address - Country:US
Practice Address - Phone:601-928-3215
Practice Address - Fax:601-928-6072
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist