Provider Demographics
NPI:1457406753
Name:THOMPSON, DENNIS RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:RAY
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:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-0667
Mailing Address - Country:US
Mailing Address - Phone:602-281-5929
Mailing Address - Fax:
Practice Address - Street 1:1125 GRANDVIEW STREET
Practice Address - Street 2:APT E1
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-0667
Practice Address - Country:US
Practice Address - Phone:602-281-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15949183500000X
TX36861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist