Provider Demographics
NPI:1104038132
Name:THOMSON, MICHAEL G (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:THOMSON
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 1:228 W HATHAWAY LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1731
Mailing Address - Country:US
Mailing Address - Phone:610-658-7272
Mailing Address - Fax:
Practice Address - Street 1:1067 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5121
Practice Address - Country:US
Practice Address - Phone:610-627-0521
Practice Address - Fax:610-627-4378
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045650L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist