Provider Demographics
NPI:1073630778
Name:THOMPSON, GLEN ALAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:ALAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-3219
Mailing Address - Country:US
Mailing Address - Phone:205-655-8634
Mailing Address - Fax:
Practice Address - Street 1:1515 6TH AVE SOUTH
Practice Address - Street 2:COOPER GREEN HOSPITAL
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-918-2352
Practice Address - Fax:205-930-3648
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist