Provider Demographics
NPI:1962122358
Name:THOMAS, UNIQUA DELANIA
Entity type:Individual
Prefix:
First Name:UNIQUA
Middle Name:DELANIA
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 1:400 NW TADPOLE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-4061
Mailing Address - Country:US
Mailing Address - Phone:850-973-7470
Mailing Address - Fax:
Practice Address - Street 1:3300 PUBLIX CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3311
Practice Address - Country:US
Practice Address - Phone:863-688-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist