Provider Demographics
NPI:1699983254
Name:THOMPSON PHARMACY INC
Entity type:Organization
Organization Name:THOMPSON PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-947-4212
Mailing Address - Street 1:324 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2535
Mailing Address - Country:US
Mailing Address - Phone:231-947-4212
Mailing Address - Fax:231-947-0301
Practice Address - Street 1:710 CENTRE ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3381
Practice Address - Country:US
Practice Address - Phone:231-947-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMPSON PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B80266OtherBLUE CROSS BLUE SHIELD
1317OtherNORTHWOOD
MI2532628Medicaid
MI0B80266OtherBLUE CROSS BLUE SHIELD