Provider Demographics
NPI:1063779023
Name:THOMPSON, JAMES R (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:WARROAD
Mailing Address - State:MN
Mailing Address - Zip Code:56763-0450
Mailing Address - Country:US
Mailing Address - Phone:218-386-2050
Mailing Address - Fax:218-386-2054
Practice Address - Street 1:310 LAKE ST
Practice Address - Street 2:
Practice Address - City:WARROAD
Practice Address - State:MN
Practice Address - Zip Code:56763
Practice Address - Country:US
Practice Address - Phone:218-386-2050
Practice Address - Fax:218-386-2054
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist