Provider Demographics
NPI:1669881033
Name:THOMPSON, ALYSSA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
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 1:608 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:CO
Mailing Address - Zip Code:80759-2714
Mailing Address - Country:US
Mailing Address - Phone:303-913-9629
Mailing Address - Fax:
Practice Address - Street 1:315 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:CO
Practice Address - Zip Code:80759-2823
Practice Address - Country:US
Practice Address - Phone:970-848-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist