Provider Demographics
NPI:1033241211
Name:THOMPSON, GARY (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9757
Mailing Address - Country:US
Mailing Address - Phone:585-243-0559
Mailing Address - Fax:
Practice Address - Street 1:3130 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:NY
Practice Address - Zip Code:14423-1218
Practice Address - Country:US
Practice Address - Phone:585-538-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist