Provider Demographics
NPI:1043884000
Name:THOMPSON, KATRINA (RPH)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
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 1:14100 RANCH ROAD 12 UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5332
Mailing Address - Country:US
Mailing Address - Phone:512-847-7520
Mailing Address - Fax:512-842-8032
Practice Address - Street 1:14100 RANCH ROAD 12 UNIT 2A
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5332
Practice Address - Country:US
Practice Address - Phone:512-847-7520
Practice Address - Fax:512-842-8032
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist