Provider Demographics
NPI:1700292448
Name:THOMPSON, CRAIG (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
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 1:1059 MEADOWLANDS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-2346
Mailing Address - Country:US
Mailing Address - Phone:651-426-5006
Mailing Address - Fax:651-426-5711
Practice Address - Street 1:1059 MEADOWLANDS DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55127-2346
Practice Address - Country:US
Practice Address - Phone:651-426-5006
Practice Address - Fax:651-426-5711
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist