Individual
DR. JACOB THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, MS
Contact information
Practice address
930 NW 12TH AVE APT 402, PORTLAND, OR 97209-3070
(217) 521-5253
(217) 521-5253
Mailing address
930 NW 12TH AVE APT 402, PORTLAND, OR 97209-3070
(217) 521-5253
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0013977
OR
183500000X
Pharmacist
03-3-29033-3
OH
183500000X
Pharmacist
051-292451
IL
183500000X
Pharmacist
055190
NY
Other
Enumeration date
04/18/2013
Last updated
03/19/2014
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