MEDICARE: THOMPSON PHARMACY, INC.

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301006927	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2359518	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912071374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMPSON PHARMACY, INC.

Provider Business Mailing Address
First Line	:	THOMPSON PHARMACY INC
Second Line	:	324 S UNION ST
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 N LONG LAKE RD
Second Line	:	STE 101
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-9601
Country	:	US
Telephone Number	:	231-947-2880
Fax Number	:	231-947-2907

Authorized Official
Title or Position	:	OWNER
Name	:	GREG THOMPSON
Credential	:	RPH
Telephone Number	:	231-947-4212

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/28/2012

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