Healthcare Provider Details

I. General information

NPI: 1093368516
Provider Name (Legal Business Name): LURA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W LEE HWY
CHILHOWIE VA
24319
US

IV. Provider business mailing address

503 PINE ST
TAZEWELL VA
24651-6200
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-3512
  • Fax:
Mailing address:
  • Phone: 276-970-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0009984
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202215056
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: