Provider Demographics
NPI:1609488766
Name:THOMPSON, LARAY ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARAY
Middle Name:ALAN
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 1:123 E WALL ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521
Mailing Address - Country:US
Mailing Address - Phone:715-479-3306
Mailing Address - Fax:715-479-7430
Practice Address - Street 1:123 E WALL ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521
Practice Address - Country:US
Practice Address - Phone:715-479-3306
Practice Address - Fax:715-479-7430
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist