Provider Demographics
NPI:1366597155
Name:THOMPSON, GINA WHITE
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:WHITE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 HUNTERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1248
Mailing Address - Country:US
Mailing Address - Phone:804-739-3780
Mailing Address - Fax:
Practice Address - Street 1:4241 HUNTERS RIDGE DR
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-1248
Practice Address - Country:US
Practice Address - Phone:804-739-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist