Provider Demographics
NPI:1790796357
Name:THOMPSON PHARMACY INC
Entity Type:Organization
Organization Name:THOMPSON PHARMACY INC
Other - Org Name:THOMPSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRINK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-442-1919
Mailing Address - Street 1:365 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-4806
Mailing Address - Country:US
Mailing Address - Phone:252-442-1919
Mailing Address - Fax:252-446-5770
Practice Address - Street 1:365 FALLS RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-4806
Practice Address - Country:US
Practice Address - Phone:252-442-1919
Practice Address - Fax:252-446-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC051113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3410470OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC335331Medicaid