Provider Demographics
NPI:1194042986
Name:THOMPSON, ASHLEY LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-2311
Mailing Address - Country:US
Mailing Address - Phone:618-524-8316
Mailing Address - Fax:618-524-2041
Practice Address - Street 1:1001 E 5TH ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-2311
Practice Address - Country:US
Practice Address - Phone:618-524-8316
Practice Address - Fax:618-524-2041
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.286038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.286038OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION