Provider Demographics
NPI:1457722399
Name:THOMPSON, BOBBY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 COUNTRY CLUB RD APT 910
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6046
Mailing Address - Country:US
Mailing Address - Phone:337-439-4241
Mailing Address - Fax:
Practice Address - Street 1:2000 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7314
Practice Address - Country:US
Practice Address - Phone:337-439-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16616183500000X
MSP010911183500000X
LAPST.020854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist