Provider Demographics
NPI:1295018844
Name:THOMSON, DELAINE III (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:DELAINE
Middle Name:
Last Name:THOMSON
Suffix:III
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 LEGACY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-1871
Mailing Address - Country:US
Mailing Address - Phone:702-300-4169
Mailing Address - Fax:
Practice Address - Street 1:1948 W CROSS HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-8325
Practice Address - Country:US
Practice Address - Phone:435-868-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6873616-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist