Provider Demographics
NPI:1225319627
Name:THOMPSON, EARL ARTHUR III (RPH)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:ARTHUR
Last Name:THOMPSON
Suffix:III
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 1:1964 FULLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4861
Mailing Address - Country:US
Mailing Address - Phone:616-364-7071
Mailing Address - Fax:616-364-7097
Practice Address - Street 1:1964 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4861
Practice Address - Country:US
Practice Address - Phone:616-364-7071
Practice Address - Fax:616-364-7097
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist