Provider Demographics
NPI:1376578286
Name:THOMPSON, JEFFERY SCOTT
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 COUNTY ROAD 138
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-6371
Mailing Address - Country:US
Mailing Address - Phone:256-767-3788
Mailing Address - Fax:
Practice Address - Street 1:313 HIGHWAY 13 SOUTH
Practice Address - Street 2:
Practice Address - City:COLLINWOOD
Practice Address - State:TN
Practice Address - Zip Code:38450
Practice Address - Country:US
Practice Address - Phone:931-724-9197
Practice Address - Fax:931-724-5381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7910183500000X
AL11677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist