MEDICARE: DR. MICHAEL THOMPSON PHARM.D.

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	174H00000X	Health Educator	PS21491	FL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS21491	FL
3	1835P1200X	Pharmacotherapy Pharmacist	PS21491	FL

General Provider Information

NPI Number	:	1598271371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THOMPSON PHARM.D.

Provider Business Mailing Address
First Line	:	1400 VILLAGE SQUARE BLVD # 3305
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	850-694-5997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 VILLAGE SQUARE BLVD # 3305
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	850-694-5997
Fax Number	:

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

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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