Provider Demographics
NPI:1982713624
Name:THOMPSON, TOMMY LYNN (DPH)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT 3 BOX 183
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73529
Mailing Address - Country:US
Mailing Address - Phone:580-439-2372
Mailing Address - Fax:580-439-2357
Practice Address - Street 1:513 HILLARY
Practice Address - Street 2:SUITE B
Practice Address - City:COMANCHE
Practice Address - State:OK
Practice Address - Zip Code:73529
Practice Address - Country:US
Practice Address - Phone:580-439-8869
Practice Address - Fax:580-439-2357
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist