Provider Demographics
NPI:1649968504
Name:THOMPSON, CASSIDAY CLARA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSIDAY
Middle Name:CLARA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 SOUTH AVE APT F19
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4472
Mailing Address - Country:US
Mailing Address - Phone:405-933-1338
Mailing Address - Fax:
Practice Address - Street 1:1800 TILDEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8181
Practice Address - Country:US
Practice Address - Phone:484-668-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR-19874183500000X
PARP457504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist