Provider Demographics
NPI:1346732211
Name:THOMPSEN, LAWRENCE GUNNAR (RPH)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GUNNAR
Last Name:THOMPSEN
Suffix:
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 1:1757 CASA GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3930
Mailing Address - Country:US
Mailing Address - Phone:626-676-4278
Mailing Address - Fax:
Practice Address - Street 1:7039 VALJEAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3915
Practice Address - Country:US
Practice Address - Phone:818-390-9696
Practice Address - Fax:818-390-9697
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35107OtherCALIFORNIA BOARD OF PHARMACY
IL051-28450OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION