MEDICARE: MR. ANDREW THOMAS THOMSON

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
1	183500000X	Pharmacist	55774	CA

General Provider Information

NPI Number	:	1154625523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW THOMAS THOMSON

Provider Business Mailing Address
First Line	:	10675 SCRIPPS POWAY PKWY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3919
Country	:	US
Telephone Number	:	858-693-1545
Fax Number	:	858-693-1313

Provider Business Practice Location Address
First Line	:	10675 SCRIPPS POWAY PKWY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3919
Country	:	US
Telephone Number	:	858-693-1545
Fax Number	:	858-693-1313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	12/28/2010

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