Provider Demographics
NPI:1174502983
Name:THOMPSON PHARMACY INC
Entity Type:Organization
Organization Name:THOMPSON PHARMACY INC
Other - Org Name:THOMPSON PHARMACY AND MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-947-8700
Mailing Address - Street 1:324 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2535
Mailing Address - Country:US
Mailing Address - Phone:231-947-4212
Mailing Address - Fax:231-947-2907
Practice Address - Street 1:324 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2535
Practice Address - Country:US
Practice Address - Phone:231-947-4212
Practice Address - Fax:231-947-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010006003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2532628Medicaid
2041160OtherPK
MI2532628Medicaid