Provider Demographics
NPI:1417324963
Name:THOMPSON, CHARLES REX II (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:REX
Last Name:THOMPSON
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-2106
Mailing Address - Country:US
Mailing Address - Phone:912-964-4311
Mailing Address - Fax:912-964-4358
Practice Address - Street 1:4210 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-2106
Practice Address - Country:US
Practice Address - Phone:912-964-4311
Practice Address - Fax:912-964-4358
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist