Healthcare Provider Details

I. General information

NPI: 1831897438
Provider Name (Legal Business Name): AMELIA THOMPSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 UNION AVE
MEMPHIS TN
38104-3625
US

IV. Provider business mailing address

5591 AUTUMN VALLEY DR
MEMPHIS TN
38135-4210
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-7828
  • Fax:
Mailing address:
  • Phone: 601-270-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46194
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: