Healthcare Provider Details

I. General information

NPI: 1932021425
Provider Name (Legal Business Name): SOPHIA GRACE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10122 E 10TH ST
INDIANAPOLIS IN
46229-2663
US

IV. Provider business mailing address

10276 LAKELAND DR
FISHERS IN
46037-9320
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-5717
  • Fax:
Mailing address:
  • Phone: 812-629-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: