Provider Demographics
NPI:1053508374
Name:THOMPSON, GREGORY BOYD (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BOYD
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 1:324 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2535
Mailing Address - Country:US
Mailing Address - Phone:231-947-4212
Mailing Address - Fax:231-947-0301
Practice Address - Street 1:324 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2535
Practice Address - Country:US
Practice Address - Phone:231-947-4212
Practice Address - Fax:231-947-0301
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI530100020114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist