Provider Demographics
NPI:1316232507
Name:THOMPSON, KRISTEN BROOKS (RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:BROOKS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3092 N EASTMAN RD
Mailing Address - Street 2:T2283
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5175
Mailing Address - Country:US
Mailing Address - Phone:903-323-5001
Mailing Address - Fax:903-323-5011
Practice Address - Street 1:3092 N EASTMAN RD
Practice Address - Street 2:T2283
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5175
Practice Address - Country:US
Practice Address - Phone:903-323-5001
Practice Address - Fax:903-323-5011
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist