Provider Demographics
NPI:1235117789
Name:THOMPSON, KENNETH L (RPH CGP)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RPH CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-8501
Mailing Address - Country:US
Mailing Address - Phone:804-435-2186
Mailing Address - Fax:804-435-1757
Practice Address - Street 1:2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-8501
Practice Address - Country:US
Practice Address - Phone:804-435-2186
Practice Address - Fax:804-435-1757
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020050151835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy