Provider Demographics
NPI:1114449824
Name:THOMSON, ALEXIS ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANNE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5942 S SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-3326
Mailing Address - Country:US
Mailing Address - Phone:315-469-3254
Mailing Address - Fax:
Practice Address - Street 1:5942 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-3326
Practice Address - Country:US
Practice Address - Phone:315-469-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist