Provider Demographics
NPI:1851675847
Name:THOMPSON, MATTHEW BAXTER (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BAXTER
Last Name:THOMPSON
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 1:421 E LANDING DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9203
Mailing Address - Country:US
Mailing Address - Phone:704-880-3087
Mailing Address - Fax:
Practice Address - Street 1:2174 BLOWING ROCK RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6154
Practice Address - Country:US
Practice Address - Phone:828-268-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist