Provider Demographics
NPI:1235860172
Name:THOMPSON, NATALIE STEPHANIE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:STEPHANIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13880 APPALOOSA CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7364
Mailing Address - Country:US
Mailing Address - Phone:760-987-3699
Mailing Address - Fax:
Practice Address - Street 1:13880 APPALOOSA CT
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-7364
Practice Address - Country:US
Practice Address - Phone:760-987-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122073183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician