MEDICARE: ROBERT LEE THOMPSON RPH

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	30740	TX
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	30740	TX

General Provider Information

NPI Number	:	1255616595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LEE THOMPSON RPH

Provider Business Mailing Address
First Line	:	13948A WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5359
Country	:	US
Telephone Number	:	281-496-1488
Fax Number	:	281-496-0455

Provider Business Practice Location Address
First Line	:	13948A WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5359
Country	:	US
Telephone Number	:	281-496-1488
Fax Number	:	281-496-0455

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/09/2013

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