Healthcare Provider Details

I. General information

NPI: 1932379120
Provider Name (Legal Business Name): JUDITH KAY THOMPSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THOMPSON JUDITH KAY RPH

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 9TH ST SE
ROANOKE VA
24013-1506
US

IV. Provider business mailing address

414 9TH ST SE
ROANOKE VA
24013-1506
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-8342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202007909
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: