Healthcare Provider Details

I. General information

NPI: 1033241211
Provider Name (Legal Business Name): GARY THOMPSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 MAIN ST
CALEDONIA NY
14423-1218
US

IV. Provider business mailing address

4375 RESERVOIR RD
GENESEO NY
14454-9757
US

V. Phone/Fax

Practice location:
  • Phone: 585-538-6140
  • Fax:
Mailing address:
  • Phone: 585-243-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32260
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: