Provider Demographics
NPI:1083965073
Name:THOMPSON & THOMPSON LONG TERM CARE
Entity Type:Organization
Organization Name:THOMPSON & THOMPSON LONG TERM CARE
Other - Org Name:VICTOR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-330-4328
Mailing Address - Street 1:205 WASHINGTON ST
Mailing Address - Street 2:PO BOX 117
Mailing Address - City:VICTOR
Mailing Address - State:IA
Mailing Address - Zip Code:52347-7778
Mailing Address - Country:US
Mailing Address - Phone:319-653-1043
Mailing Address - Fax:319-653-1063
Practice Address - Street 1:205 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:IA
Practice Address - Zip Code:52347-7778
Practice Address - Country:US
Practice Address - Phone:319-647-8292
Practice Address - Fax:319-647-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1624368OtherNCPDP PROVIDER IDENTIFICATION NUMBER