Provider Demographics
NPI:1578707840
Name:THOMPSON, ALICIA JACQUELINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:JACQUELINE
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 1:3817 FRIENDLY ACRES DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2872
Mailing Address - Country:US
Mailing Address - Phone:336-282-2579
Mailing Address - Fax:336-282-2579
Practice Address - Street 1:3330 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4806
Practice Address - Country:US
Practice Address - Phone:336-297-1467
Practice Address - Fax:336-297-1467
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist