Healthcare Provider Details

I. General information

NPI: 1467445882
Provider Name (Legal Business Name): DARRELL W THOMPSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WESTERN STATE HOSPITAL 9601 STEILACOOM BLVD. SW
TACOMA WA
98498-7213
US

IV. Provider business mailing address

406 SHERIDAN PL
STEILACOOM WA
98388-3034
US

V. Phone/Fax

Practice location:
  • Phone: 253-756-2521
  • Fax:
Mailing address:
  • Phone: 253-278-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00011229
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: