Provider Demographics
NPI:1700023975
Name:THOMPSON, GAROLD KEITH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GAROLD
Middle Name:KEITH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 SPRINGLOT RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2216
Mailing Address - Country:US
Mailing Address - Phone:931-648-8487
Mailing Address - Fax:
Practice Address - Street 1:2205 SPRINGLOT RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2216
Practice Address - Country:US
Practice Address - Phone:931-648-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH 03209576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist