1053465302 NPI number — PATTI MOODY THOMPSON RPH

Table of content: PATTI MOODY THOMPSON RPH (NPI 1053465302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053465302 NPI number — PATTI MOODY THOMPSON RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
PATTI
Provider Middle Name:
MOODY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053465302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
369 CEDARBEND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35634-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-766-4295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11350 HIGHWAY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35633-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-766-4200
Provider Business Practice Location Address Fax Number:
256-766-9566
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  13267 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13267 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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