Provider Demographics
NPI:1689247942
Name:THOMPSON, KRISTI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
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 1:17 E 335 S
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-5752
Mailing Address - Country:US
Mailing Address - Phone:208-430-4379
Mailing Address - Fax:
Practice Address - Street 1:1310 POMERELLE AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2048
Practice Address - Country:US
Practice Address - Phone:208-878-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4794555-1701183500000X
IDP5673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist