Provider Demographics
NPI:1437405263
Name:THOMPSON, VICKIE S
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13092 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-1421
Mailing Address - Country:US
Mailing Address - Phone:731-443-3927
Mailing Address - Fax:901-465-6906
Practice Address - Street 1:13092 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1421
Practice Address - Country:US
Practice Address - Phone:731-443-3927
Practice Address - Fax:901-465-6906
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000044070183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician