1760920698 NPI number — DR. HEIDI CATHERINE THOMPSON PHARMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760920698 NPI number — DR. HEIDI CATHERINE THOMPSON PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
HEIDI
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STULTZ-GRIFFEY
Provider Other First Name:
HEIDI
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760920698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2237 WESTOVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48846-2145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-260-0260
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 DIVISION AVE S STE 1C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-685-1100
Provider Business Practice Location Address Fax Number:
800-380-1226
Provider Enumeration Date:
02/12/2017

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:  5302044614 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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