MEDICARE: MR. BRIAN LEE THOMPSON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	044052	MO

General Provider Information

NPI Number	:	1609514041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN LEE THOMPSON RPH

Provider Business Mailing Address
First Line	:	125 COURT ST
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-1807
Country	:	US
Telephone Number	:	573-243-3524
Fax Number	:	573-243-2155

Provider Business Practice Location Address
First Line	:	125 COURT ST
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-1807
Country	:	US
Telephone Number	:	573-243-3524
Fax Number	:	573-243-2155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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