Provider Demographics
NPI:1427172816
Name:THOMPSON, LOUIS E (MS, RPH)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MS, RPH
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 850
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32634-0850
Mailing Address - Country:US
Mailing Address - Phone:352-591-1977
Mailing Address - Fax:
Practice Address - Street 1:15060 N.W. 112TH AVE.
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:FL
Practice Address - Zip Code:32634-0850
Practice Address - Country:US
Practice Address - Phone:352-591-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14646OtherPHARMACY LICENSE