Provider Demographics
NPI:1700253788
Name:THOMPSON, LAKIN RAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAKIN
Middle Name:RAE
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 1:5881 VETO RD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-8166
Mailing Address - Country:US
Mailing Address - Phone:740-516-3004
Mailing Address - Fax:
Practice Address - Street 1:500 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2012
Practice Address - Country:US
Practice Address - Phone:740-516-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist