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General NPI Number Information
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NPI Number | 1588038251
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Entity Type | Individual
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Provider Name | DR. PORTIA DAWN THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 311 E MAIN ST
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City | FLOYD
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State | VA
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Zip | 24091-2131
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Country | US
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Telephone | 540-580-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 102 WEST OUTER DR
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City | CANYON LAKE
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State | TX
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Zip | 78133-5164
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Country | US
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Telephone | 540-580-6797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 55122
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License Number State | TX
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