Healthcare Provider Details

I. General information

NPI: 1629965611
Provider Name (Legal Business Name): JEREMIAH THOMPSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 N GERMANTOWN PKWY
CORDOVA TN
38016-5962
US

IV. Provider business mailing address

9246 SPEERBERRY LN
CORDOVA TN
38016-0900
US

V. Phone/Fax

Practice location:
  • Phone: 901-624-9637
  • Fax:
Mailing address:
  • Phone: 901-264-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number48877
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number025117
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number102080
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: