Provider Demographics
NPI:1295439065
Name:THOMPSON, JALEN ISAIAH (CPHT)
Entity type:Individual
Prefix:
First Name:JALEN
Middle Name:ISAIAH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1355
Mailing Address - Country:US
Mailing Address - Phone:845-298-2351
Mailing Address - Fax:845-298-4024
Practice Address - Street 1:1604 ROUTE 9
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1355
Practice Address - Country:US
Practice Address - Phone:845-298-2351
Practice Address - Fax:845-298-4024
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy