MEDICARE: MRS. AMY BETH 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	044033	MO

General Provider Information

NPI Number	:	1780728444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY BETH THOMPSON RPH

Provider Business Mailing Address
First Line	:	1632 TANGLEWOOD RD
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-1079
Country	:	US
Telephone Number	:	573-243-8403
Fax Number	:	573-264-4741

Provider Business Practice Location Address
First Line	:	2220 MAIN ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1329
Country	:	US
Telephone Number	:	573-264-2450
Fax Number	:	573-264-4741

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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