Healthcare Provider Details

I. General information

NPI: 1043885791
Provider Name (Legal Business Name): AMY RACHELLE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 116TH ST NE
MARYSVILLE WA
98271-8423
US

IV. Provider business mailing address

15557 10TH AVE NE
SHORELINE WA
98155-6209
US

V. Phone/Fax

Practice location:
  • Phone: 360-653-5178
  • Fax:
Mailing address:
  • Phone: 406-210-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60954998
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: