Provider Demographics
NPI:1316237985
Name:THOMPSON, NATHANAEL MBAYA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:MBAYA
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4889 AUGUSTA WOODS CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9180
Mailing Address - Country:US
Mailing Address - Phone:614-937-4957
Mailing Address - Fax:614-895-5442
Practice Address - Street 1:4889 AUGUSTA WOODS CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9180
Practice Address - Country:US
Practice Address - Phone:614-937-4957
Practice Address - Fax:614-895-5442
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00074371835P1200X
OH0312749411835P1200X
KY0148701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy