Provider Demographics
NPI:1013239813
Name:THOMPSON, MARSHALL R (RPH)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:R
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 1:976 NE ANGELEE PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6820
Mailing Address - Country:US
Mailing Address - Phone:541-740-4772
Mailing Address - Fax:541-754-5577
Practice Address - Street 1:777 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-754-5583
Practice Address - Fax:541-754-5577
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9481183500000X
OR00094811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist