Provider Demographics
NPI:1962556621
Name:THOMPSON, PAMELA K (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
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 1:21051 178TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-7506
Mailing Address - Country:US
Mailing Address - Phone:319-465-2041
Mailing Address - Fax:
Practice Address - Street 1:304 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1503
Practice Address - Country:US
Practice Address - Phone:319-465-4404
Practice Address - Fax:319-465-5009
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist