Provider Demographics
NPI:1639450497
Name:THOMPSON, CETRA DENISE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CETRA
Middle Name:DENISE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 22ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1203
Mailing Address - Country:US
Mailing Address - Phone:202-776-9084
Mailing Address - Fax:202-776-0969
Practice Address - Street 1:1217 22ND ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1203
Practice Address - Country:US
Practice Address - Phone:202-776-9084
Practice Address - Fax:202-776-0969
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH10000769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist