Provider Demographics
NPI:1912071374
Name:THOMPSON PHARMACY, INC.
Entity Type:Organization
Organization Name:THOMPSON PHARMACY, INC.
Other - Org Name:THOMPSON PHARMACY OLESONS WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-947-4212
Mailing Address - Street 1:THOMPSON PHARMACY INC
Mailing Address - Street 2:324 S UNION ST
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 N LONG LAKE RD
Practice Address - Street 2:STE 101
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9601
Practice Address - Country:US
Practice Address - Phone:231-947-2880
Practice Address - Fax:231-947-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010069273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2359518OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI4161823Medicaid
0237030001Medicare NSC