Healthcare Provider Details

I. General information

NPI: 1023136819
Provider Name (Legal Business Name): DONALD L THOMPSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MAIN ST
BOTTINEAU ND
58318-1202
US

IV. Provider business mailing address

810 OHMER ST P.O. BOX 85
BOTTINEAU ND
58318-1621
US

V. Phone/Fax

Practice location:
  • Phone: 701-228-2291
  • Fax:
Mailing address:
  • Phone: 701-228-5194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3906
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: