Provider Demographics
NPI:1386669539
Name:THOMPSON, EVERETT D (RPH)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:D
Last Name:THOMPSON
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 1:303 GOODRICH DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2814
Mailing Address - Country:US
Mailing Address - Phone:816-776-3761
Mailing Address - Fax:816-776-3144
Practice Address - Street 1:401 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1975
Practice Address - Country:US
Practice Address - Phone:816-776-6926
Practice Address - Fax:816-776-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist