Provider Demographics
NPI:1750356531
Name:THOMPSON, NATHAN S (RPH, MBA)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1315
Mailing Address - Country:US
Mailing Address - Phone:410-530-1989
Mailing Address - Fax:
Practice Address - Street 1:2400 BROENING HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6612
Practice Address - Country:US
Practice Address - Phone:410-288-8022
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD14982OtherPHARMACY LICENSE