Healthcare Provider Details

I. General information

NPI: 1376578286
Provider Name (Legal Business Name): MR. JEFFERY SCOTT THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 LEE ST
ROGERSVILLE AL
35652-7606
US

IV. Provider business mailing address

2742 COUNTY ROAD 26
ROGERSVILLE AL
35652-5242
US

V. Phone/Fax

Practice location:
  • Phone: 256-247-5451
  • Fax: 256-247-7866
Mailing address:
  • Phone: 256-810-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7910
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11677
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: