Healthcare Provider Details

I. General information

NPI: 1225319627
Provider Name (Legal Business Name): EARL ARTHUR THOMPSON III RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 FULLER AVE NE
GRAND RAPIDS MI
49505-4861
US

IV. Provider business mailing address

1964 FULLER AVE NE
GRAND RAPIDS MI
49505-4861
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-7071
  • Fax: 616-364-7097
Mailing address:
  • Phone: 616-364-7071
  • Fax: 616-364-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028335
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: