Healthcare Provider Details

I. General information

NPI: 1144435355
Provider Name (Legal Business Name): TOMMY LESTER THOMPSON PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HARRELL ST
TRION GA
30753
US

IV. Provider business mailing address

49 HARRELL ST
TRION GA
30753
US

V. Phone/Fax

Practice location:
  • Phone: 706-734-2481
  • Fax: 706-734-7787
Mailing address:
  • Phone: 706-734-2481
  • Fax: 706-734-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH009748
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: