Provider Demographics
NPI:1598083651
Name:THOMPSON, ALBA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:MARIE
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 1:1610 SAN MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7124
Mailing Address - Country:US
Mailing Address - Phone:949-644-6422
Mailing Address - Fax:
Practice Address - Street 1:1610 SAN MIGUEL DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7124
Practice Address - Country:US
Practice Address - Phone:949-644-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist