Provider Demographics
NPI:1174854103
Name:THOMPSON, TANYA LEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LEA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LEA
Other - Last Name:MCNAIR-THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4620 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4624
Mailing Address - Country:US
Mailing Address - Phone:480-354-8013
Mailing Address - Fax:
Practice Address - Street 1:2226 S DUVAL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2270
Practice Address - Country:US
Practice Address - Phone:480-354-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist