Healthcare Provider Details

I. General information

NPI: 1174502983
Provider Name (Legal Business Name): THOMPSON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S UNION ST
TRAVERSE CITY MI
49684-2535
US

IV. Provider business mailing address

324 S UNION ST
TRAVERSE CITY MI
49684-2535
US

V. Phone/Fax

Practice location:
  • Phone: 231-947-4212
  • Fax: 231-947-0301
Mailing address:
  • Phone: 231-947-4212
  • Fax: 231-947-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301000600
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK THOMPSON
Title or Position: VP
Credential: RPH
Phone: 231-947-8700