Healthcare Provider Details

I. General information

NPI: 1124318548
Provider Name (Legal Business Name): LISA MARIE THOMPSON PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E SHIRLEY ST
MOUNT UNION PA
17066-1600
US

IV. Provider business mailing address

PO BOX 185
MILL CREEK PA
17060-0185
US

V. Phone/Fax

Practice location:
  • Phone: 814-542-8003
  • Fax: 814-542-4229
Mailing address:
  • Phone: 724-541-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442391
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: