Provider Demographics
NPI:1972630770
Name:THOMPSON, JESSICA NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
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 1:1149 JONES ST
Mailing Address - Street 2:APT C
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5451
Mailing Address - Country:US
Mailing Address - Phone:405-514-3439
Mailing Address - Fax:
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13953183500000X
NV176181835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist