Provider Demographics
NPI:1437757002
Name:THOMPSON, SHIRLEY KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
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:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:LAND O' LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54540
Mailing Address - Country:US
Mailing Address - Phone:715-547-3788
Mailing Address - Fax:715-547-6901
Practice Address - Street 1:LAND O' LAKES PHARMACY
Practice Address - Street 2:4348 HWY B
Practice Address - City:LAND O' LAKES
Practice Address - State:WI
Practice Address - Zip Code:54540
Practice Address - Country:US
Practice Address - Phone:715-547-3788
Practice Address - Fax:715-547-6901
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10436-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist