Provider Demographics
NPI:1962075499
Name:THOMAS, VASAVI (PHARMACIST (PHARMD))
Entity type:Individual
Prefix:
First Name:VASAVI
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHARMACIST (PHARMD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 IDLEWOOD PARC CT
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:703-403-9504
Mailing Address - Fax:
Practice Address - Street 1:VETERAN'S HOSPITAL ATLANTA
Practice Address - Street 2:1700 CLAIRMONT RD
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:800-827-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherNONE