Provider Demographics
NPI:1508314576
Name:THOMPSON, GREGORY B (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
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 1:1137 S DOBSON RD # 10
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-3902
Mailing Address - Country:US
Mailing Address - Phone:480-964-1411
Mailing Address - Fax:
Practice Address - Street 1:1137 S DOBSON RD # 10
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-3902
Practice Address - Country:US
Practice Address - Phone:480-964-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist