Individual
MIKE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5020 GRAPE RD, MISHAWAKA, IN 46545-8708
(574) 273-3520
Mailing address
5020 GRAPE RD, MISHAWAKA, IN 46545-8708
(574) 273-3520
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26091881A
IN
Other
Enumeration date
05/21/2014
Last updated
05/21/2014
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