Provider Demographics
NPI:1003248345
Name:THOMPSOM, HEATHER ANN FAGAN (CPHT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN FAGAN
Last Name:THOMPSOM
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6868 SKY POINTE DR
Mailing Address - Street 2:2063
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-6101
Mailing Address - Country:US
Mailing Address - Phone:702-576-7243
Mailing Address - Fax:
Practice Address - Street 1:6868 SKY POINTE DR
Practice Address - Street 2:2063
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-6101
Practice Address - Country:US
Practice Address - Phone:702-576-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPT02778183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician