Provider Demographics
NPI:1447689153
Name:THOMPSON, KEITH (RPH)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:KEITH
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1700 MCFARLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3276
Mailing Address - Country:US
Mailing Address - Phone:205-339-0155
Mailing Address - Fax:205-339-1316
Practice Address - Street 1:1700 MCFARLAND BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3276
Practice Address - Country:US
Practice Address - Phone:205-339-0155
Practice Address - Fax:205-339-1316
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist