Basic Information
| Provider Information | |||||||||
| NPI: | 1932516051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | FREDRICK | ||||||||
| MiddleName: | ROSS | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5915 JOHNSON POINT RD NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985169150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604561043 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1401 GALAXY DR NE | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985164746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604567862 | ||||||||
| FaxNumber: | 3604567864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2014 | ||||||||
| LastUpdateDate: | 07/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH00021177 | WA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | RP00004371 | NM | N | Pharmacy Service Providers | Pharmacist |
No ID Information.