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NPI Code Detail

MEDICARE: HEATHER ANN FAGAN THOMPSOM CPHT

MEDICARE: HEATHER ANN FAGAN THOMPSOM CPHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy TechnicianPT02778NV

General Provider Information

NPI Number : 1003248345
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER ANN FAGAN THOMPSOM CPHT
Provider Business Mailing Address
First Line : 6868 SKY POINTE DR
Second Line : 2063
City : LAS VEGAS
State : NV
Zip : 89131-6101
Country : US
Telephone Number : 702-576-7243
Fax Number :
Provider Business Practice Location Address
First Line : 6868 SKY POINTE DR
Second Line : 2063
City : LAS VEGAS
State : NV
Zip : 89131-6101
Country : US
Telephone Number : 702-576-7243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2013
Last Update Date : 08/08/2013

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