Provider Demographics
NPI:1518566603
Name:THOMPSON, AMANDA LOUISE
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LOUISE
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 1:2090 RAYWICK RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-9218
Mailing Address - Country:US
Mailing Address - Phone:859-576-0917
Mailing Address - Fax:
Practice Address - Street 1:705 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1701
Practice Address - Country:US
Practice Address - Phone:270-692-2123
Practice Address - Fax:270-692-4532
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist