Provider Demographics
NPI:1639292352
Name:THOMSEN, RICHARD L (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:THOMSEN
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 1:1202 BREMER RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-4147
Mailing Address - Country:US
Mailing Address - Phone:319-352-4698
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:IA
Practice Address - Zip Code:50658-9482
Practice Address - Country:US
Practice Address - Phone:641-435-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist