Healthcare Provider Details

I. General information

NPI: 1053628453
Provider Name (Legal Business Name): LINNEA DIANE THOMPSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 491 NORTHERN NAVAJO MEDICAL CENTER ATTN PHARMACY DEPARTMENT
SHIPROCK NM
87420
US

IV. Provider business mailing address

HWY 491 NORTHERN NAVAJO MEDICAL CENTER ATTN PHARMACY DEPARTMENT
SHIPROCK NM
87420
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-7252
  • Fax: 505-368-7254
Mailing address:
  • Phone: 505-368-7252
  • Fax: 505-368-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 00020290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: