Provider Demographics
NPI:1174022172
Name:THOMPSON, DAVID MARK (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2408
Mailing Address - Country:US
Mailing Address - Phone:806-544-6840
Mailing Address - Fax:806-788-2016
Practice Address - Street 1:4425 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2408
Practice Address - Country:US
Practice Address - Phone:806-544-6840
Practice Address - Fax:806-788-2016
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist