MEDICARE: DARRELL W 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	PH00011229	WA

General Provider Information

NPI Number	:	1467445882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL W THOMPSON RPH

Provider Business Mailing Address
First Line	:	406 SHERIDAN PL
Second Line	:
City	:	STEILACOOM
State	:	WA
Zip	:	98388-3034
Country	:	US
Telephone Number	:	253-278-6844
Fax Number	:

Provider Business Practice Location Address
First Line	:	WESTERN STATE HOSPITAL
Second Line	:	9601 STEILACOOM BLVD. SW
City	:	TACOMA
State	:	WA
Zip	:	98498-7213
Country	:	US
Telephone Number	:	253-756-2521
Fax Number	:

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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