Healthcare Provider Details

I. General information

NPI: 1962994186
Provider Name (Legal Business Name): NEIL PETER THOMPSON PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 19TH AVE S
MINNEAPOLIS MN
55407-3402
US

IV. Provider business mailing address

4048 19TH AVE S
MINNEAPOLIS MN
55407-3402
US

V. Phone/Fax

Practice location:
  • Phone: 612-246-4788
  • Fax: 612-284-1022
Mailing address:
  • Phone: 612-246-4788
  • Fax: 612-284-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number112703
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: