Provider Demographics
NPI:1346682879
Name:THOMPSON, MARY ALINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD
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 33
Mailing Address - Street 2:6380 GULLEDGE ROAD
Mailing Address - City:WEDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29168-0033
Mailing Address - Country:US
Mailing Address - Phone:803-494-9853
Mailing Address - Fax:
Practice Address - Street 1:6500 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1603
Practice Address - Country:US
Practice Address - Phone:803-695-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist