MEDICARE: MR. SHAWN THOMPSON

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	11016	KY

General Provider Information

NPI Number	:	1619250354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN THOMPSON

Provider Business Mailing Address
First Line	:	11099 HIGHWAY 44 E
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-6243
Country	:	US
Telephone Number	:	502-538-4271
Fax Number	:	502-538-4591

Provider Business Practice Location Address
First Line	:	11099 HIGHWAY 44 E
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-6243
Country	:	US
Telephone Number	:	502-538-4271
Fax Number	:	502-538-4591

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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Directions to “ MR. SHAWN THOMPSON ” Practice Location

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