Healthcare Provider Details

I. General information

NPI: 1437405263
Provider Name (Legal Business Name): MS. VICKIE S THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13092 N MAIN ST
SOMERVILLE TN
38068-1421
US

IV. Provider business mailing address

13092 N MAIN ST
SOMERVILLE TN
38068-1421
US

V. Phone/Fax

Practice location:
  • Phone: 731-443-3927
  • Fax: 901-465-6906
Mailing address:
  • Phone: 731-443-3927
  • Fax: 901-465-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000044070
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: