Provider Demographics
NPI:1164407433
Name:THOMPSON, GWENDOLYN H (PHARMD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:H
Last Name:THOMPSON
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 1:17522 WIEDERSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3846
Mailing Address - Country:US
Mailing Address - Phone:210-916-3239
Mailing Address - Fax:210-916-2535
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:MCHE QD CREDS
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-2460
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20381208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology