Provider Demographics
NPI:1437153947
Name:THOMPSON, BRENT JASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JASON
Last Name:THOMPSON
Suffix:
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 1:1628 RAINBOW ST
Mailing Address - Street 2:
Mailing Address - City:GRASSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55030-9725
Mailing Address - Country:US
Mailing Address - Phone:320-396-5037
Mailing Address - Fax:
Practice Address - Street 1:301 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1899
Practice Address - Country:US
Practice Address - Phone:320-225-3595
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116677-8183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist