Healthcare Provider Details

I. General information

NPI: 1609074103
Provider Name (Legal Business Name): ANNE MARIE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4789 FIREFLY DR NE
GRAND RAPIDS MI
49525-9308
US

IV. Provider business mailing address

4789 FIREFLY DR NE
GRAND RAPIDS MI
49525-9308
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-0481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: