Provider Demographics
NPI:1932516051
Name:THOMPSON, FREDRICK ROSS (RPH)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:ROSS
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 1:5915 JOHNSON POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9150
Mailing Address - Country:US
Mailing Address - Phone:360-456-1043
Mailing Address - Fax:
Practice Address - Street 1:1401 GALAXY DR NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-4746
Practice Address - Country:US
Practice Address - Phone:360-456-7862
Practice Address - Fax:360-456-7864
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021177183500000X
NMRP00004371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist