Healthcare Provider Details

I. General information

NPI: 1609145390
Provider Name (Legal Business Name): SUZANNE MARIE THOMPSON PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2011
Last Update Date: 12/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 BEAL PKWY NW
FORT WALTON BEACH FL
32547-1955
US

IV. Provider business mailing address

187 BROOKS ST SE A-202
FORT WALTON BEACH FL
32548-3724
US

V. Phone/Fax

Practice location:
  • Phone: 850-314-0851
  • Fax: 850-314-7830
Mailing address:
  • Phone: 850-314-0851
  • Fax: 850-314-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS45909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: