Provider Demographics
NPI:1629615737
Name:THOMPSON, KAYLYN RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:RENEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10694 TWISTED HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-8612
Mailing Address - Country:US
Mailing Address - Phone:910-872-3916
Mailing Address - Fax:
Practice Address - Street 1:2811 N PARK DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7485
Practice Address - Country:US
Practice Address - Phone:919-778-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist