Provider Demographics
NPI:1083205710
Name:THOMPSON, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N. I-35
Mailing Address - Street 2:
Mailing Address - City:BELLMEAD
Mailing Address - State:TX
Mailing Address - Zip Code:76705
Mailing Address - Country:US
Mailing Address - Phone:254-799-0219
Mailing Address - Fax:
Practice Address - Street 1:801 N. I-35
Practice Address - Street 2:
Practice Address - City:BELLMEAD
Practice Address - State:TX
Practice Address - Zip Code:76705
Practice Address - Country:US
Practice Address - Phone:254-799-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183700000X
183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician