Healthcare Provider Details

I. General information

NPI: 1508581893
Provider Name (Legal Business Name): MARY THOMPSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MAIN ST
HOOSICK FALLS NY
12090-2002
US

IV. Provider business mailing address

21 PEACH TREE LN
GANSEVOORT NY
12831-2604
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-5831
  • Fax:
Mailing address:
  • Phone: 940-235-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0019211
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: