Provider Demographics
NPI:1568670933
Name:THOMPSON, ELIZABETH JETER (R PH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JETER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HAMPTON POINT DR
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5446
Mailing Address - Country:US
Mailing Address - Phone:912-634-8716
Mailing Address - Fax:
Practice Address - Street 1:5711 ALTAMA AVE
Practice Address - Street 2:UNIT J
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-2240
Practice Address - Country:US
Practice Address - Phone:912-264-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist