Provider Demographics
NPI:1366091068
Name:THOMPSON, RACHEL NICOLE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:NICOLE
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 LACY TER
Mailing Address - Street 2:
Mailing Address - City:ARAPAHO
Mailing Address - State:OK
Mailing Address - Zip Code:73620-9772
Mailing Address - Country:US
Mailing Address - Phone:580-214-0139
Mailing Address - Fax:
Practice Address - Street 1:1001 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-3256
Practice Address - Country:US
Practice Address - Phone:580-774-1200
Practice Address - Fax:580-774-1212
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist